A plea from a fellow independant

Working for an independent gives you sort of a bond with other independent pharmacists. From shitty reimbursements to dealing with patients; we don’t have the luxury of a ‘corporate office’ and people in suits with fancy lawyers to cover our asses.
So I recieved this letter from a pharmacist in California. Since he claims he has bitched to everyone he can get his hands on via phone, I think its time to give some good ole public harassing.

TAP,
My name is [Name Removed] from [Store Name Removed] in [City Removed]. California. Long time listener, first time caller. First off love your website. I was wondering if you could light a fire under a problem that I’ve been having.
In case you are not from California, our Medicaid system (Called MediCal) has a 6 Rx limit per patient per month. Any Rx over 6 needs to have a Treatment Authorization Request filled and sent in (Think of it as a retarded prior auth that they approve for like 6 months to a year). Since it is being done electronically now vs fax, the usual turnaround time was a day or two for maintenance medications and a bit longer for stuff that was non formulary.
Over the past few months, I have been getting TAR’s back for stuff like Lisinopril, HCTZ, glyburide with only 3 authorizations. Now why they would only give 3 fills for something the patient is on chronically is beyond me. To make matters worse, the turnaround times for maintenance meds is now approaching close to 14 days in some instances. Imagine if I did not dispense insulin or digoxin to a patient until I got that TAR back so I could get paid.
So I call the TAR office, and they say the delay is because they are “Really Busy” (yeah, who isnt?). Them giving us only 3 fill units on a lisinopril Rx is like if I dispensed 10 tablets at a time then used the “Really Busy” bullshit when they bitched as to why its taking so long.
I think they are giving away a low amount of refills for approved maintenance medications to save their own jobs. Unfortunately their shortsightedness is giving them such a backlog that approvals are not being sent out in a timely manner and people are not getting their medications.
I hope you publish this letter to your site to light a fire under the MediCal TAR office and to see if any other pharmacist from CA is having the same problem. I can be reached at [email TAP for address].
Thanks
[Name Removed] RPh

Thats pretty shitty if the MediCal TAR office is screwing over TAR’s that THEY THEMSELVES REQUIRE in order to save their jobs. I always thought that PA approvers are just pharmacists/techs who could not cut it in the “real world” so they have to get some desk job hiding from the public behind an ID number so they cant be called out for being a fucking retard. If there is anyone from the MediCal office reading this, why don’t you get your own shit in order before you force your problems down the throats of the pharmacists who actually work for a living. I have his email address if you wish to get a hold of him and explain your case. 3 fills for a maintenance med, thats fucking absurd. “We’re busy” is also fucking absurd. Wah wah wah, cry me a fucking river and let me powder your balls while we’re at it. Hate to break it to you, but we ALL are busy, and judging from this letter you are just adding more shit onto this poor independent.
I’m just glad that there are still some people out there like myself who will fill an Rx even though they will not get paid this very moment just so they don’t end up in the hospital (actually, I think all pharmacists will do this, huge $ items excluded of course, we’re kind but we need to eat too).

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7 Comments

  1. Just Another CA pharmacist says:

    I’m a pharmacist from California and have NEVER understood the rational behind the Medi-Cal’s greater than 6 TAR. Often times, when a patient reaches the 7th (and more) prescription(s), our pharmacy will back out previously filled and less expensive prescriptions. Afterwards, we fill the 7th one (and others), so that the patient can have their chronic medications, which are often more expensive. A greater than 6 TAR will be requested for the previously filled and less expensive prescriptions. Most patients who usually require a > 6 TAR monthly, are the ones, who are on multiple chronic medications and can’t wait for the TARs to get approved, so the our pharmacy will dispense the prescriptions without up-front reimbursement. SIGH!!!

  2. Jerry says:

    Everyone in CA is having this same problem. But I understand the Medi-Cal regulations state that if they cannot respond in 1 working day, to either defer, deny, or approve a TAR then they are obligated to give you at least 1 approval. I have called them to task several times on this and I always get at least 1 approval. You might check. I have to agree that the whole system is a mess and not designed to give good health care. Anyone wanting the government to take over the entire healthcare system is frankly in need of a mental examination.

  3. one_angry_tech says:

    God, that sounds worse than Indiana Medicaid!

  4. Matt says:

    i dont know, i dont totally disagree with this policy. they should waiver out things like diabetes and asthma and preventitive drugs for conditions like hypertension, but i think it would be great if they had more stringent PAs for benzodiazepenes, pain meds, convience things like cough syrups/OTCs etc while its a pain in the ass it would help curb wasteful tax spending and keep people from getting candy bags with a bunch of garbage drugs they only need to support their addiction

  5. Mary Augustine says:

    Correct me if I’m wrong, but I didn’t have the impression that PAs folks were people that had prior knowledge of drugs before working in that capacity.

  6. AnonymousGrl says:

    I use the little mom and pop pharmacy down the street. My whole family uses it. We have one charge account there and my little brother is very ill and requires tons of medications each month. Last spring, my mom had a stroke and no one knew it. Long story short, she stopped paying that bill (and all bills)…and a few months later, the pharmacist started getting upset.
    After only a few months, the pharmacy bill added up to 9 grand (my lil bro is very sick and doesn’t have health insurance…our state is really nice to children, as you can tell). We started paying it in small payments and he still let’s us charge our meds, but I’m just wondering if secretly he’s uber-sick of us and wants us to go away (we’ve known him as a family for 40 years or something..).
    Does a 9 – 10 thousand dollar charge account bill really hurt a mom and pop place? I feel so terrible about this situation and I don’t know what to do.

  7. 5150 says:

    Long time reader, first time poster. This hit so close to home that I actually registered to post.
    The current backlog seems to have started right at the end of 2007. The online TAR system was so fast that sometimes the turnaround was 3 hours. Right after Christmas that has changed, dramatically. I called Stockton field office on Friday (1/11) and the lady told me they’re currently processing 12/26 and 12/27s. WTF? Something fishy is going on. It just can’t change from a 2-day turnaround to 2 weeks because “they’re busy”, which was also the reason the lady gave me.
    Didn’t know about that 1 fill policy. Gotta try that on Monday for my 15 pending TARs. Should be fun.

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