Sanford R. Altman For Times Herald Record I recently received a prescription from a local pharmacy. It was for a…
I recently received a prescription from a local pharmacy. It was for a medicine that required a handwritten prescription from my doctor instead of his office, just dial it.
So I got shocked when I went to pick it up a few days later and the pharmacist told me that my Medicare Part D insurance plan now required that, in addition to my doctor’s handwritten recipe, I needed a form completed by my doctor for prior authorization . The pharmacist also said that I could only pay out of pocket, which would cost me $ 19 instead of $ 6. I was just about to pull out my credit card and pay $ 19 so I would not waste the time calling my doctor, but because I did not need the medicine right away, I stopped. With my background of advocating for seniors, I was suspected of the transaction and decided to dig a little deeper.
When I called my doctor, he confirmed that this would mean paperwork on his part and suggested that I go to a cheaper pharmacy. He obviously had experience of this phenomenon and was not happy. Then I called the insurance company that handles my Part D plan. I asked why my doctor would have to fill in a form when he had already written a handwriting.
The customer service rep told me that there was a list of medicines that came from the Geriatric Journal for people over the age of 65 (most Medicare recipients) and the insurance company decided that all medications on the list would require fork certification. I later found what I assumed to be “the list” and it contained pages and pages of medicines. I asked the ropes if this was the law or just the plan’s plan. The rope did not know.
So suddenly it hit me. If someone retired heard the same option as I heard from the pharmacy ̵
1; go back to your doctor and get the form signed or pay the full price from the pocket – and needed a prescription immediately, they would immediately dig for their credit card. Or if they had difficulty getting to the pharmacy or demanding a trip to get there, or someone else had picked up the recipe for them, they would probably pay the higher price. Most of whom I would suggest would rather pay out of their pocket than to jump through all the hoops just because they could get the recipe filled.
What does this mean to the insurance company? That means another prescription that they do not have to pay for. Multiply it with the 43.2 million retirees who are dependent on Medicare Part D recipe plans, and this is a big email for insurance companies. Seniors pay them for the insurance, and companies do not have to cover the recipe. In short, it’s a bluff. It’s subtle and it works. The only difference is that these plans have probably been screened by the federal government, so seniors are much less likely to suspect that there is something underhanded in this.
My doctor later told me that it is well known in his profession that when an insurance company requests additional documentation, it is nothing more than “a money grab.” I could solve my case because I was reluctant, but many seniors would rather take the faster route by just paying out-of-pocket. But we should fight. And our representatives should fight. If my assessment is correct and other plans follow the same procedure, the number of elderly people and the undue profits received by the state-sanctioned insurance companies are staggering!
Sanford R. Altman is a senior lawyer and senior lawyer. He is a member of the Alzheimer’s Association and the Office for Aging Advisory Councils and Chairman of the Town of Montgomery Seniors Independence Project. He can be reached at [email protected] and 845-800-0650. This column is intended to provide general legal information, not specific legal advice.