The Med Diva

An insider's guide to Medicare Part D and more

Archive for the tag “prescription drugs”

Medicare Drops the Ball on New Mail-Order Pharmacy Rule for Part D Members

Medicare drops the ball on seniors

I recently posted two articles about a new Medicare Part D rule that affected beneficiaries who get their medications delivered on a regular basis from a mail-order pharmacy. The rule, which went into effect on January 1, required all pharmacies with home delivery services to get direct consent from Part D plan members before shipping each and every medication.

Today I have some good news to share: The enlightened folks at Medicare have decided that — surprise, surprise — this new rule did not work as intended. Last week, much to our relief, the Centers for Medicare & Medicaid Services (CMS) rescinded the rule.

Full details are still pending, but as of now, you do not need to give your pharmacy permission to ship the medications you regularly receive by mail. It’s probably not quite as simple as this, so if I hear more, I’ll let you know.

If you’re still not familiar with the rule I’m referring to, I’m not surprised. Medicare did a very poor job communicating the details of the rule with Part D plans and beneficiaries.

In a nutshell, the rule required pharmacies to get consent from the plan member (by phone or online) every time the member’s doctor submitted a new prescription or a refill on an existing prescription was ready to be shipped. If the pharmacy didn’t get the member’s consent, it could not ship the medication. No consent, no medication. Period.

As soon as I heard about this rule back in November, I knew it was a recipe for disaster. This rule, I thought, had the potential to create a serious safety issue for seniors and other Medicare beneficiaries. I was right.

Without guidance and communications from Medicare, Part D plans and their members were left in the dark. I tried to provide clear information about the rule for our plan members, but even I found it too complicated to fully understand and explain.

By the first week of March – just two months after the rule went into effect – hundreds of thousands of prescriptions were being held up in mail-order pharmacies throughout the country. Medicare beneficiaries didn’t receive the medications they needed because they didn’t know about the rule or understand how to provide consent. I’m sure many people were very worried and confused when their medications didn’t arrive in the mail on time as expected.

So as I let out a huge sigh of relief, I have something to say to CMS: You really screwed up on this one. By not providing clear communications to Part D plans and members about this complex rule, you created a major safety issue for seniors. You didn’t think it through and consider all the logistics and implications. You dropped the ball and left it up to Part D plans and pharmacies to put it back in play, even though you didn’t provide the rules of the game.

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Changes to Automatic Refill Services Under Medicare Part D Mail-Order Pharmacies in 2014

Part D Mail-Order Pharmacy

If you are a Medicare beneficiary who gets your medications from a Medicare Part D mail-order pharmacy, I have some important information that may affect your services starting in January 2014.

Many mail-order or home delivery pharmacies provide an automatic refill service that will automatically ship your prescription drugs when you are about to run out of medication. For example, if you have a 90-day prescription for a certain medication, the mail-order pharmacy will automatically ship a refill when you have about two weeks of medication left. This service is very convenient, especially if you take several medications, and it has always been one of the main advantages of using a mail-order pharmacy.

Unfortunately, in recent years some prescription drug plans weren’t periodically checking to find out if their customers still wanted or needed their drugs. The automatic refill service was simply put on auto-pilot, so to speak, and would send the medication to the person’s home every three months or so. Once you received that drug in the mail, you were stuck with it whether you still needed it or not.

Since pharmacies are not allowed to restock prescription drugs that are sent by mail, some automatic delivery services were creating a lot of waste and unnecessary additional costs for people with Medicare and the Part D program in general. So the Centers for Medicare & Medicaid Services (CMS) decided to take action.

Starting January 1, 2014, mail-order pharmacies (and retail pharmacies with home delivery service) must get your approval before they will ship or deliver a new prescription or refill. That means that if you normally get refills every three months, you will need to provide your consent every three months for every medication. Even if your doctor calls in a new prescription, you will still need to provide your authorization. The pharmacy will not be able to ship your medication until you confirm you want to get the order.

Depending on your mail-order pharmacy, you may have to go to a website or reply to an email to provide authorization, or the pharmacy may call you on the phone to get your consent. Either way, the pharmacy will need to reach you before shipping every order, so make sure they have your most current phone number or email address. Until someone from the pharmacy reaches you and gets your consent, the pharmacy will not be able to process the order and ship your medication.

Keep in mind that if you place an order for medication yourself — whether by phone, mail, or online — you will not have to provide additional consent when the medication is ready to be shipped. Also note that this new policy won’t affect refill reminder programs at retail pharmacies when you go in person to pick up the medication. It also won’t apply to long-term care pharmacies that give out and deliver prescription drugs.

If you are currently using a Medicare Part D mail-order pharmacy, you should be receiving a notice by mail or email regarding this change in service. The notice should provide information that is specific to your plan and your pharmacy. If you don’t receive a notice by the first week of January, you should contact the mail-order pharmacy to confirm that your correct contact information is on file.

Don’t toss my work in the trash: Give your Part D mail-order pharmacy a try!

Part D Mail-Order Pharmacy

The other night at our holiday party, the VP of my department asked me if I was still writing my Medicare blog. I told him I had taken a hiatus because I was simply “swamped” at work with a major campaign to entice Medicare beneficiaries to use their plan’s mail-order pharmacy (we call it home delivery pharmacy service).

For the past few weeks, I have been writing several letters that tout the benefits of home delivery in order to convince people who take drugs on a regular basis to switch from their retail pharmacy to mail order. I know for a fact that my company’s Medicare Part D plan bombards our Medicare members with such letters every year. I apologize—it’s not my fault, I swear! I also know that many people are reluctant to switch to mail order—or absolutely refuse to try it—and toss all my hard work in the garbage.

I have to admit I put off using my plan’s mail-order pharmacy at first, simply because I didn’t want to deal with the paperwork involved. I thought it would be a hassle to switch my one prescription from my favorite retail pharmacy. But when I used my plan’s price comparison tool and discovered I would pay about $100 less every 90 days with mail, I immediately made the switch. 

Guess what? It wasn’t a hassle at all! The customer service rep did all the work for me–she even called the doctor to get my prescription–and in a few days my medication arrived in a secure package in my mailbox.

I can’t say anything bad about home delivery. I can order up to a 3-month supply of my medication for a lot less money than a 30-day supply at my pharmacy. My drugs arrive in my mailbox, so I don’t have to drive to the pharmacy when I don’t feel well or the weather is bad. And I never have to wait in line to pay because there’s never a line at my mailbox!

If I have to work late, I don’t have to worry about the pharmacy closing before I get home — after all, my mailbox never closes!  Best of all, my mail-order pharmacy sends me automatic refill reminders by e-mail, so I never forget when it’s time to refill. I can order refills online, which takes about 2 minutes.

If the above sounds like a pitch, you’re right. But I really believe in it, and know it could save you time and money.

I like to tell my friends and family that using mail order for our drugs is no different from using mail order for buying books (Amazon), DVDs (Netflix), or any other product we buy online. So please don’t throw my letter in the trash – give mail order a try. If you really don’t like it, you can always switch back.

Hand-written prescriptions can kill you: 1.5 million reasons to ask your doctors to use e-prescribing

Having worked as a news reporter for almost 20 years, my handwriting is atrocious, thanks to countless hours spent taking fast and furious notes the old-fashion way (paper and pen). It’s so bad, in fact, that many people have told me I should have been a doctor.

If you’ve ever had a hard time reading a prescription or trying to guess what your doctor wrote, you know why my friends thought I chose the wrong career. I always laugh when they say this, but illegible prescriptions are no joke. That’s why it’s important to request your doctors use electronic prescribing, better known as e-prescribing, if they are not already using this technology.

According to the Institute of Medicine (IOM), approximately 7,000 deaths and at least 1.5 million preventable injuries are caused by medication errors every year in the U.S. These errors are largely due to:

• Illegible hand-writing
• Wrong dosages
• Look-alike drug names
• Missed drug interactions
• Failed allergy checking

How does e-prescribing work?

Instead of writing out your prescription on a piece of paper at the end of your visit, your doctor enters it directly into a computer or hand-held device. Your prescription instantly travels from your doctor’s office to the pharmacy’s computer. E-prescriptions are always sent electronically through a private, secure, and closed network – your personal information is never sent over the open Internet or as e-mail.

The benefits of e-prescribing for you

Although it may take a while to get used to e-prescribing, the following benefits make this new-fangled technology fantastic for you in terms of time, cost-savings, and safety:   
• Fast – Your prescription arrives at your pharmacy before you even leave your doctor’s office. (Please note: This does not mean your medication will be ready as soon as you get there.)
• Convenient – You don’t have to make that extra trip to drop off your prescription at the pharmacy or take time to send it to your mail-order pharmacy.
• Safe – Your pharmacist does not have to interpret or “guess” what the prescription says, so it will be filled correctly with the right medication and the right dose.
• Time-saving – Your doctor will know right away if the prescribed drug is covered by your plan, so your prescription will not get rejected at the pharmacy.
• Economical – E-prescribing makes it easy for your doctor to prescribe the most cost effective medication based on your Medicare coverage.

Not quite perfect yet

According to several pharmacist bloggers, e-prescribing does have some pitfalls, especially since doctors and other healthcare providers are human and thus, are capable of entering the wrong drug name or wrong dosage into their computer.  Many pharmacists stress that patients should always request a paper copy of the prescription as a backup in case the pharmacy believes a data entry error was made.

Find out if your doctor and pharmacist use e-prescriptions

To find out if your healthcare provider uses e-prescribing, click here and enter your city and state or zip code. If you want to see if your pharmacy accepts e-prescriptions, click here.

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