Medicare D

[The Hated Consultant]

How does your facility handle problems arising from resident's Medicare D plans?

We seem to have a huge problem here with quantity limits, formulary changes, etc.

[CapeCodMermaid, RN]

We do the best we can and play the game. If the patient needs a med that requires a prior auth., we pay for a few doses until the paper work can be processed. If that doesn't work we explain to the docs that they will have to pick a medication which is on that patient's insurance formulary.

[noc4senuf]

We also will pay for a 3 day supply of the medication until the pharmacy can reach the doc and explain to them the problem. The docs have always then ordered something that will be covered by the formulary.

[lamazeteacher]

We also will pay for a 3 day supply of the medication until the pharmacy can reach the doc and explain to them the problem. The docs have always then ordered something that will be covered by the formulary.

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That's encouraging to hear. When an HMO refused to pay for the only (prescription) med that worked to curb my gerd (Prevacid XR) I called the administration, asking why I had to pay them, to suffer on meds that didn't work. They hung tough, and despite my concern about samples being used as an excuse for the high prices pharmaceutical companies charge (sheer bullroar, as the pens, dinners for docs, etc. cost 10X that, and if less unrecyclable packaging of samples was used, it would be even less).