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Sunday, February 5, 2023

We. . .

ME: Of what do you dream?
MICE ELF: We obviously know what's in your head, but what would you like to see as a change no one is discussing right now?
CP: Sweeping insurance changes. 
ME: Pffft. Lame. Everyone wants that. 
MICE ELF: I pheel there is something deeper here. Proceed. 
CP: "We the Pharmacy People of the United States, in Order to phorm a more perfect practising environment, lessen wait times, improve healthcare phor our patients, and to put the "care" back in healthcare, do ordain and establish these Rules phor a Universal Insurance Reform. 
ME: You could've just said "I have a dream" instead of being all old-timey. 
MICE ELF: Continue. What do you hope to see?
CP: Ultimately, I want insurance billing to not be our responsibility; I want the fight to be behind the scenes.
1. Let us collect only an "office visit copay" for each medication. 
2. Let the billing/coverage/prior auth conversation happen in the background like your prescriber's office or the hospitals do. (Your MRI needs a PA? Can't get it until the insurance covers it. Your medication needs a PA? Dr. Zoffis can't send the Rx until it's covered.)
3. Allow ALL claims for covid shots or vaccines to be payable instantly. We should not have to enter an administration fee, an SC Code of 02, 03, 06, 07, 10 or anything else. It's covered: Just pay for it. No rejections. 
4. You know it's only available as a 91-day pack, pay for it. Don't make me back it down to 30 days then try to recover DIR fees because it once got filled early on an auto-fill since YOU made me change it to less than it actually is. 
5. a) I want reject messages that actually match the rejection. Like this one: "Prior auth required in patients >1yo". This was for Omeprazole 20mg capsules. After extensive work and a considerable amount of time, the ACTUAL rejection was for "NDC not covered". Yep. Simply switching to another NDC, albeit not one of my preferred items, allowed the claim to process without issue. 
b. Ins limits to 83 days - translation: patient must use mail order, or we can only bill for 30 days; it could be either, neither, or both. Say what you mean and mean what you say, Horton. 
6. Pick a days supply and universally pay phor it. No more, "max of 30 days, max of 34 days, please submit phor 90 days" or, the new Medicare one, "please submit for 100 days". Yep received a TIP phor that. Just pay phor 100 days across the board. All patients qualify phor 4 phills per year. Makes their definition of compliance much easier to attain. 
7. DIR fees - I can't make someone compliant if they are dead. I can't make them compliant if they move or are phorced to use another pharmacy. I can't make them pick up their medications if the doctor determines they no longer need to be on it. I can't make them compliant if they can't afford the copays YOU are charging them. 
8. One Universal Pharmacy card with only Pharmacy Benefits Information on it. 
a. BIN
b. PCN
c. ID#
d. Person Code of each covered member
e. 1-800-Help-You phone number phor members and 1-800-Helps-Me for pharmacies
Hopefully this will cut down on the insurers that insist on sending out cards with incorrect information, or as the letter I received last week indicated, the ID and Groups numbers switched on the card. 
ME: Anything else?
CP: I started this post last summer and have been adding to it. I'm sure the phine phollowers will have astute observations of their own to add. 
MICE ELF: Lofty girls, my phriend. 
CP: This post became more elaborate when all I really wanted was to not be responsible phor all this crap at the pharmacy. Especially now with all the added tasks phor which we are responsible. 
ME: And don't receive payment. 
CP: Honestly, I'd be happy with any of these. 

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