I try to post positive, proactive articles, but I felt this needed to be posted.
This week, our pharmacy received a prescription from a physician's office for a customer who has been with us for a long time. The prescription was for a nebulizer medication and we have filled it in the past. When we got the order, we ordered the medication which costs over $385.00. First we billed the customers Medicare part D coverage, received a rejection that we needed to bill Medicare part B. The allowable on Part B for this medication is way below our cost, even if we bill an additional administrative fee we still would lose 6.00. Since we had been paid previously (our cost only) on the part D plan, we called the physician's office to start the prior authorization process. This all started on Monday. Today, we found out that the patient received the medication through the mail. We are very happy that the patient has the medication he needs, but this is one patient and one example of what a pharmacist does to fill a medication. We spend more time navigating the rules and regulations of the healthcare system, just to try and cover our costs. Our time is not considered one bit in the reimbursement. If the system was less complicated the pharmacists could spend more time counselling patients without worrying whether we can stay in business. In this particular situation, we now have to spend additional time to return the medication we ordered.