Other times it pops up when a maintenance medication is trying to be filled at the local retail pharmacy and the patient's plan requires mail-order after the first two fills at the local pharmacy. I get that. I expect that..... in March or April.
Not on January 2.
I had that message appear on one of the first prescriptions that I filled last Saturday. And since then about two scripts per day. A little bit ridiculous.
Oh wait, I forgot to tell you what the secondary message said:
-Please have customer call CVS Caremark 888-769-9030
Now you know what's going on. Even though my pharmacy is contracted with CVS Caremark, I'm only allowed to fill one prescription for my patients, then I have to tell them that they need to either go to the CVS that is two miles away or start mail-ordering. Somehow this doesn't seem right to me.
But stuff like this has been going on for years. And it's not exclusively CVS Caremark.
This is what happens when insurers of prescription medications are permitted to be providers. They set up little rules that force the patients to use them. Want to use a non-preferred pharmacy? No problem... copay will be doubled... if they allow you to use the non-preferred provider.
A year or so ago I called an insurance company to see how I was being reimbursed for a particular medication that I felt our pharmacy was being low-balled on. I wanted to know which formula was being used.
I think it was the insurance company's MAC-plus list, because I couldn't get the math to work out using any of the other formulas that were included in our contract. I asked for a copy of the insurer's MAC-plus list to be emailed to me.
So here's where we are. Insurance company (who is also a provider) gets to pick and choose which reimbursement levels the contracted pharmacies receive. They won't let us see the list of medications that are on each list. We just have to trust them.
I wonder if the reimbursements are also based on NCPDP numbers. Maybe the locations that are affiliated with the insurer get a little bit higher reimbursement levels. Competitors get a little bit lower levels. Hmmm.... I wonder how the insurance company's profits are doing?
Just some things to think about.