When is a prescription really just one prescription?

     Good evening everyone, hope all is going well?  Tonight I want to ask everyone, When is a prescription really just one prescription? What do I mean by this?  Has Richard finally lost it? What I mean is, if you visit your doctor say for edema (excess water retention) and the doctor provides you with a prescription for the first month and with two refills, is this considered one prescription or three?  Should it be mandatory for the pharmacy to have to contact your insurance company to obtain approval once, when you first take in the prescription or for the first month, first refill and again for the second refill?  I hope that makes sense?  

     The reason I ask is 80% of the time I go in to pick up a prescription I’m told one of three things;

  • We have to get approval.
  • We have to fill the prescription.
  • Insurance has denied the prescription.

     See because my medical (at least those related to my back) is covered by Workers Compensation (WC), I have a total of four different insurance companies that cover my expenses, yes four.  The State of California over the years has picked up or taken over all the Workers Compensation insurance companies due to they have pretty much all gone out of business.  As my luck would have it about two years ago they brought in a middle man, Temisis Group who deals with the doctors and pharmacies and if there are any questions, approvals, etc. they contact the insurance company and then report back.  Here are the steps that workers compensation patients have to take to get medicine;

  1. I pick up or the doctor calls in the prescription to the pharmacy.
  2. The pharmacy has to contact The Temisis Group for approval.
  3. The Temisis Group then has to contact the appropriate insurance company for approval and is always done via voice mail, no email which make way to much sense.
  4. The insurance companies have to make their decision, slow as molasses. Then they call the doctor or pharmacy back.
  5. Now doctor can write prescription or pharmacy can fill it.  If its the first one (doctor writes script) the patient then has to got through steps 1-4 all over again.

     With this in mind, my history of dealing with the Workers Compensation medicine related approval process I would highly suggest you “HAND CARRY” your prescriptions or have the doctors office call them in while informing the pharmacy of when you will be picking them up.  This then will get the pharmacy moving and hopefully get you a faster approval from workers compensation.  Now keep in mind my original question, When is a prescription really just one prescription?  I have to go through this process with each and every prescription I pick up, no matte if it is the original prescription or one of its two refills, which I have been on for going on 14 years and have always had the original prescription with two refills.  So is this (or should this) be considered one prescription or three?  Should a patient have to go through all of the above steps for a “refill” on a prescription that’s already been approved?

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  1 comment for “When is a prescription really just one prescription?

  1. 01/04/2014 at 6:23 pm

    Your place will be valueble for me. Cheers!

    Like

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