What recourse does a patient have if every pharmacy that they go to refuses to fill their scripts? Pharmacies where we had prescriptions filled for over 2 years are now refusing to fill legitimate scripts provided by our pain management doctors.
My wife had to visit the emergency room 3 times last year at great cost to us retirees because of withdrawal symptoms from pain medications.
I talked to my insurance provider about the situation and they said that they would like us to report the contracted pharmacy back to them so their legal department could take care of it.
Stephen G. from central Florida
I am glad that your insurance company wants to get involved. I have not heard much about insurers taking an interest in pharmacies refusing to honor the terms of their contracts. But that could be changing.
There is a five star rating system that is being expanded in the Medicare Advantage program starting in 2015. It now applies to Advantage/Part D providers. If insurers and pharmacies lose enough “stars” due to complaints or other customer service issues, it will affect their level of reimbursements from the government. If they lose enough stars they risk being thrown out of the program.
In theory, the initial focus is supposed to be on medication compliance by patients with chronic conditions such as diabetes, high cholesterol and high blood pressure. But managing a patient’s chronic disease states should be across the board for all disorders – including chronic pain.
Your insurance company is accepting premiums to provide you with certain services and products. That insurance policy is basically a contract. If you can’t find a pharmacy to fill your prescription, then you need to tell the insurer that they are not meeting the terms of your insurance contract and that you will file a complaint with the state insurance commission and the Centers for Medicare and Medicaid Services for insurance fraud.
Tell them that they need to find you a local pharmacy – in their network – to fill your prescriptions.
If you feel you are being discriminated against because of a medical condition, that is a civil rights violation under the Americans with Disability Act (ADA). Click here to file a complaint with the ADA. You don’t need an attorney to file a complaint.
In my opinion, what you are experiencing is discrimination under the ADA: patient/senior abuse and denial of care. Federal and state agencies should go to bat for you if you file complaints.
If for some reason they do not, I would contact the local investigative reporters of TV stations.
Steve Ariens is a pharmacist and patient advocate. Steve has over 40 years’ experience as a pharmacist in Indiana and Kentucky, and has served on the board of directors of the Indiana Pharmacists Alliance and on steering committees for the National Community Pharmacists Association.
Steve’s wife is a chronic pain patient. You can learn more about Steve by visiting his blog at Pharmacist Steve.
If you have a question for Steve, send it to AskthePharmacist@nationalpainreport.com.
The information in this column is not intended to be considered as professional medical advice, diagnosis or treatment. Only your doctor can do that! It is for informational purposes only and represents the author’s personal experiences and opinions alone. It does not inherently or expressly reflect the views, opinions and/or positions of National Pain Report or Microcast Media.