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Saturday, June 18, 2011

Refill Too Soon

People do not understand copay issues.  The don't read their explanations of benefits that answer all the questions they could have.  The only issue more elusive for them is the Refill Too Soon concept.  On the surface it seems pretty self-explanatory.  Your refill is too soon.  It is too soon to be filled.  It is too early.  It is not yet due.  It is not ready to be filled.  Not today.  Customer customer go away, come again another day.
However, like anything else, we must assume stupidity trumps common sense and investigate further.  Why is this such an enigmatic problem?  What piece of the equation are they missing?   
Most of these conversations begin the same way with "I am sorry, but your refill is too soon by 1 day".  Believe me, the 1-day early is worse than telling them it's a week or 10 days early.  I will always get asked "well if it's only 1 day can't you just fill it?"  Um, No.  If it was due today, we would not be having this intellectual back-and-forth, this witty tete-a-tete.  Instead, I get to explain what you have yet to wrap your head around.  The insurance (easier to explain) will not pay for it yet because it is 1 day too soon according to their records.  What this means is that you actually should have 8 days worth of medication at your house, so in other words, plenty.  As in you do not need it urgently, or today.  See you tomorrow.  
Most insurances require a percentage-complete to be met before they will pay for you to have more.  On a 30-day supply, an 80% complete requirement translates to you having taken 24 days of medication, leaving you with 6 days.  This means that 1 day early means you have 7 days.  Get it?  You have medication.  You are not out yet.  Perhaps you like to stockpile, you're a hoarder.  Awesome.  What you need to understand here is that someone else is paying for your stash.  They don't mind being a mild enabler, but they will not help you get on a reality show with your mass accumulation of medication.  

Cash customers are another issue.  Personally, I'd be happy if you wanted to buy all 365 tablets of your Hydrochlorothiazide 25mg today so I don't have to see you for a year.  As long as it's not a controlled substance you can pay cash for whatever you want.  If your doctor writes on your prescription "Do Not Fill Until...." then expect me to obey that.  Again, not my fault, not my problem, nothing I can do.  No. I will not call to override it.  If you're going on vacation, tell me before I process everything.  I have to call your insurance for an override.  Please do not wait until you are in my drive-thru to pick up your stuff as you are heading to the airport.  There is more work involved.  You have been planning this for a while.  I am sure this vacation did not come about last minute and surprise you.  Don't surprise me.  

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