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CommentaryPrimary Care

Medication Management Details

By April 15, 2016February 21st, 2020No Comments

Staff request that I remind everyone of some of the nitty-gritty of medication management. We work hard to assure that you receive the medications you require accurately and timely, and not others, especially obsolete ones. But working with the various pharmacy benefit managers is challenging for all of us. Here are a few relevant tips.

Mail Order Medications

We cannot directly manage your mail order account. We certainly send prescriptions to your intermediary (e.g., Caremark or Express Scripts) by fax or electronically, but only you know exactly when the renewals will be needed and whether you activated automatic refill and so forth. So please pay attention to your own specific needs and allow us adequate time to generate new prescriptions when they are needed. That would be several (two to three) weeks in advance to allow for our verifying and sending out the new prescriptions, and for you to receive the refill.

That is why we try to do annual refills for 90-day scripts for all your continuing meds at your annual checkup. That is the most effective and efficient approach.

Prior Authorization for Medications

When a drug intermediary requires a prior authorization for you to receive a medication I recommended (or occasionally one you requested), there is substantial administrative and clinical work to be done by our nurses and often by me personally to arrange the approval (which we do not always receive). Please expect this will occupy a week’s time, including sometimes a few days for us to collect the relevant information to convince the drug plan that the request is valid, and then 3-5 days till they respond. We are usually effective at getting approval, but this is not a trivial nor quick task.

Formulary Changes

Every insurance plan has a unique drug plan that may have a unique formulary. We have no way of tracking exactly what drugs your personal pharmacy plan will cover. In general I prescribe generic medications that should be covered by most drug plans, and usually are, which minimizes coverage problems. But many situations still arise in which case your prescription is turned down at the pharmacy because it is not in your formulary. In such cases we may swap to an alternative equally effective drug (when we learn of the denial), and other times we move for a “prior authorization” (see above) if we think it is technically important. This is time-consuming for us, as well as for you. Patience and coordination are┬áneeded from all involved.

Stopping Medications From Mail Order

We may frequently change medications to improve your care, either if you no longer need the medication or if it appears there is an alternative that would be better for you. In such cases you need to contact your mail-order pharmacy to turn off any auto-refill of the canceled medication. We have no realistic way to cancel previous refillable prescriptions at a mail-order pharmacy.

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