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The Near-Epic Pharmacy Battle (long and possibly confusing)

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  • The Near-Epic Pharmacy Battle (long and possibly confusing)

    I don't even know how this is happening, but it's driving me batty. For the past year, I've been waging war with... well, I don't know who.

    I take Expensive Drug for my hayfever allergies. It works great. There's a few others like it, but all of them fall into one of two groups. Either they don't work because they make me puke, or they work about as well as nothing at all -- rather expensive nothing.

    Every month, my pharmacy's computer calls and announces that my refills are ready. It might even tell us what drugs have been filled; I don't know. I just delete the voicemail and make a mental note to swing by the pharmacy later that evening. There, I find waiting for me, my happy thyroid pill, and... about 50% of the time, a generic allergy medication in the same class as Expensive Drug, but it is a generic of one of the "makes me puke" drugs. I then have to reject it and request they fill Expensive Drug instead. The other 50% of the time, I get Expensive Drug like expected.

    The first time this happened, I was called out of the blue by our doctor, and asked if I'd like a script for the new generic for Expensive Drug, so I said yes. Cheap is good, after all.

    I found out after the first dose that it is not what I was promised. The generic won't come out until 2017, in fact. We asked the doctor, and they said the pharmacy called to inform them of the new drug. We asked Rocking Pharmacist, who said that it's possible that our insurance company's mail-order pharmacy made the request, and the only reason it went to the local store was because our doctor got my approval, then just called the pharmacy on my record. She also de-activated the wrong prescription, and filled my proper one, and I went on my way. Now, as I've said, the wrong drug gets submitted for auto-fill about every other month.

    Rocking Pharmacist isn't sure why or how, especially since the prescription was only good for one refill, and should have expired in July 2011. You'll notice it is now July 2012. They've mistakenly filled a drug that I don't have a valid prescription for, 5 times in the past year. Rocking Pharmacist researched this and found out that my insurance company (who owns the chain pharmacy also) submits it as a refill request, about every other month.

    I was at my doctor's office today, because I have a back injury and the "what to do when Maria hoses her back" playlist isn't cutting it this time. But while I was there... they went through my basic history, including current medications they have listed that I take. Item one was my thyroid medication. Item two? If you guessed it was Wrong Generic, instead of Expensive Drug, you're right! They said that Pharmacy called them to report that my script had expired, and since my allergies don't require a whole lot of follow-up care, they just sent a new prescription, and made the change in my file. Pharmacy has no clue who called my doctor. In fact, THEY said my doctor's who's been asking for the drug to be refilled all this past year, even though my doctor has no record of it, and has a big "DO NOT PRESCRIBE GENERIC DRUG!" scrawled across my file folder.

    So at this point, we THINK that Insurance Goons have been calling my doctor, posing as my pharmacist, trying to get a valid script, and when they're thwarted by my doctor's Sharpie-note on the file, they call the pharmacy posing as my doctor. And now that it made it into my record erroneously, I'm concerned as all hell because Generic Drug is NOT FAA-approved. So this could very well cost me my career if they don't knock it off and get it the hell out of my file. And I have no idea how to make this nonsense stop. I hate to have an erroneous drug allergy listed in my medical record, but, it's starting to look like the best possible option.

    And sure enough, I just pulled up my online account with Pharmacy. There is a new, valid prescription for Generic Drug. Somebody conned the doctor's PA into doing the script. I have no idea how to fix this.

    And what's worse, we now, as of this month, have to get all of our regular daily meds from our insurance's mail-order pharmacy instead of in-store. I bet they send the wrong drug at least twice before they send the right one.

  • #2
    Sounds illegal, but the question is who to report the insurance to.
    "Is it hot in here to you? It's very warm, isn't it?"--Nero, probably

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    • #3
      Explain to your doctor, the pharmacist, and your insurance company that this needs to stop as it is endangering your job. I learned real quick to not mess around with the FAA when they wanted to take my hair pins, never mind what happened when they came around and heard I was just back from having a c-section and wanted a list of my pain meds (I refused). Tell you doctor what has happened, and that they need to find who in their office is going behind their back and reordering the incorrect meds.

      If your insurance company is pretending to be your doctor, I believe that is illegal as is pretending to be the pharmacist. I don't know who your insurance is or what state this is taking place in, but your Attorney General should be able to help.

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      • #4
        Well I'd suggest ... one of the following: a lawyer, local medical board, or the FBI*.


        regardless of which you go to, the question is going to be the same really...

        "My insurance company has been calling the pharmacy pretending to be my doctor, prescribing medications that don't work for me. What actions can I take to put a stop to this?"



        * might be overkill though but hey it's an option at least. (one that might scare the shit out of them tho...)
        Last edited by PepperElf; 07-06-2012, 12:50 PM. Reason: My autocorrect thinks the "fbi" should be the "fib" O_o

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        • #5
          I had similar problem

          Have you let your HR/Risk management people know that someone is changing your doctor's orders?

          I had a similar problem with our insurance trying to push a particular allergy med that gave me epic week to month long nose bleeds. I called our HR/Risk Management team and told them what was going on. I was told this was completely unacceptable and would be handled. Doctor's office told me they got a contrite apology and my scripts were approved correctly from there out. Then next open enrollment we switched insurance companies. We were told we were switching because of numerous complaints of unethical behavior by the insurance company.

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          • #6
            Quoth PepperElf View Post
            regardless of which you go to, the question is going to be the same really...

            "My insurance company has been calling the pharmacy pretending to be my doctor, prescribing medications that don't work for mepeople doing my job are not permitted to take. What actions can I take to put a stop to this?"
            Edited slightly, since (for at least one of the organizations suggested) the legal issues are more likely to light a fire under someone's butt than something that could be interpreted as the patient being a drug-seeker (asking for a particular medication tends to be interpreted as drug-seeking behaviour).
            Any fool can piss on the floor. It takes a talented SC to shit on the ceiling.

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