Welcome to the start of Week 2 of hell, er.. Medicare Part Diaster!
Today we have a very very special award. It goes out to Prescription Solutions powered by PacifiCare.
Today is the start of week 2, and my place of employment is STILL not enrolled in their Medicare part D program. Last week they were backlogged, this week they really dont know whats going on and why we’re not signed up. I left voicemails to their contract department telling them that they better act on this to stem the outflow of patients that soon will be switching to a medicare part D carrier that has their shit together.
Do they care? nah. Just another random voice after a 20 min hold time giving another BS excuse.
Its besides the point that we faxed over our contract not once, but twice, about 2 weeks apart, plus mailed the hard-copy to them. All this was the first part of December.
Typical insurance run-around. They arent suffering any; the patients are because they dont wish to change pharmacies (bless their hearts) yet their insurance company completely dropped the ball.. ROCK – ME – HARD PLACE
Argus is still on the crap-list for having slow/unresponsive servers. Get with the program dudes, its been a week. BUY MORE FUCKING MACHINES TO TAKE THE LOAD. QUIT SPENDING YOUR MONEY ON HOOKERS AND BLOW AND BUY MORE GODDAMN SERVERS SO YOU CAN SERVICE THE PEOPLE WHO PAY YOUR DAMN PAYCHECK! (i feel better now). If thats not the case, then tell us WHY your service sucks, and why companies that use you for Rx processing (like Health Net) shouldnt sue your ass into oblivion for making them look horrible. Ive worked in the computer industry, I know how things can get, and I know that keeping everyone informed. Plus I love how their main webpage (http://www.argushealth.com) has a huge area about KickBack..er.. Rebates! Way to go! Why dont you use that and BUY MORE SERVERS!
Shouts out to Mike in IN, stick with it man, we’ll get through this! Once in a while you get that pearl in the rough that makes your job worth while. I know I get mine on a daily basis.. If this site would be about all the good parts about pharmacy it wouldnt be called ‘theangrypharmacist’ now would it.. 🙂
Friend of mine from school made this website to help you all with the ins and outs of Rx processing through MediCare part D. It has stuff like what person code to put, ANSI BIN numbers, PCN numbers, etc. Its a wiki, so anyone can create an account and add information and stuff (there is a hand holding page to help out). He’s put a ton of time in so let him know how you like it. Heres the address
Tell your friends and co-workers.
Day two of the MediCare part D fiasco has come and gone.
I must say, that this is the biggest clusterfuck in the last 40 years of pharmacy.
For example: Argus Health Systems (a billion dollar company) had its servers taken down for some reason all day. Unfortunally Humara and HealthNet uses Argus’ servers to process their prescriptions.
This means that nobody who was signed up for HealthNet could get prescriptions today. Only 1/2 of Humara patients could get their prescriptions today.
Pharmacies are turning people away without medication because they dont know if the cards are good, and arent going to risk the 100 bucks worth of medication to find out.
Patient care has taken a back-seat to gun-shy pharmacies who are getting fucked over by cost+$2.00 reimbursement fees. Cant say I blame them, patient care doesnt put food on the table or pay for the power.. I tipped the pizza boy more than we get per Rx via MediCare part D.
So the pharmacies get fucked and the patient gets fucked.. Who comes out ahead? The insurance companies thats who (who are recording record high profits last quarter).
I’m amazed at the lack of preparedness that the insurance companies have shown. You would think that a good 6 month prep-time and “record high profits” could prepare them with the necessary hardware and personel to take the phone and transmission load that was expected on the first.
I’m waiting for the blame on Bush or the republicans to come out, even though its the private sector that totally fucked over everyone. Last I checked the government didnt have control of HealthNet, Argus, Blue Cross or any private third party. But I guess someone has to have the finger pointed at them. If the government would of just managed it itself like they did the state welfare program, everyone would be in the same boat, and we wouldnt have 50 companies with 50 standards and 50 formularies to deal with.
There is no excuse as to why Argus’ computers were down all day today. If this was a single man operation, then I could see. But this is a multi-billion dollar corporation. You would expect a bit of forethought and preparedness.
But it gets better! Who gets blamed for Argus’ systems being down, the copays where there was none, and all this chaos? ME! Thats right, your local neighborhood pharmacist who has nothing to do with this whole batshit gets blamed. People want to blame someone they have access to, so they blame us. As if I control argus’ systems (I could probably do a better job administrating them) or control their copays.
So fuck you Argus and fuck you Heath Net for dropping the ball during the time of need. People will die because of your fuckups, its the blood of the elderly (and the frustation of every pharmacy out there) will stain your ‘record high profit’ reports (as if you care).
Its a sad sad day for pharmacy today.
In the words of my boss:
Patients are being sent to the pharmacy with cards that have the WRONG ID number on them, which forces us to call the insurance company to wait on hold for a half hour or so.
The central eligibility server is down, so you cannot online check to see which of the 90 plans the patient is signed up for.
“More people will die because of MediCare Part D than Hurricane Katrina”.
In the words of me:
“This is a complete and utter clusterfuck”.
Its horrible, examples:
Since all of the Medicaid (welfare) patients with Medicare are moved over to Medicare part D now, they have copays. They are used to getting their medication for free, so they bitch and moan when they have to pay a measly $1 for generics and $3 for brand name. My reponse to them: “Get the fuck over it, you should of saved your money when you were young. I’m tired of paying into a system that will benefit you and no longer be around for me. Personal responsiblity begins young and at home. Remember the story of the grasshopper and the ant. You douchebags are the grasshopper and i’m the ant. My grandparents came to this country with nothing and have enough investments to retire on. They didnt even speak english when they came here! So suck it up, be a man/woman and forgo the one night eating out at hometown buffet to pay the $17 for all of your monthly medications. People who dont qualify for government assistance have to pay cash, and you dont see them bitching about it you fucking whiners.”
I feel better now.
Insurance companies have hit an all time low. Not only do they:
Change card info without telling anyone
Pay us cost + $1.50 for medications
Leave you on hold for 30 min before they tell you the card info was changed.
Did I mention they change the damn card information and dont tell anyone?
But they also outsource most of their call centers to India!
Now what sort of fucked up shit is that? Here you are, swamped to all hell, trying to get some dildo’s prescription filled for that whole cost+$1.50 only to get some douchebag in India who cannot speak english (or speaks english like a robot)..
Not only are insurance companies totally fucking over the consumer (it’ll cost you $200/month to cover those whole 20 drugs), and the pharmacist (AWP-35% okay?) but they are also fucking over the working class (you know, the people who sign up and pay these people their paycheck) by employing people in another country rather than hiring the hard working men/women who’s brothers and sisters help pay the power bill. No wonder why they are bragging about huge profits each year, they fuck over everyone in the process!
So next time you’re on the phone with some (un)helpful customer service rep, ask them where they are located… If they say “India”, thank them for their kind service, and promptly change your personal insurance to one that does not oursource that crap out.
Talk to any pharmacist and mention the word “Prior Authorization” to watch him/her instantly have a hemmoragic stroke.
Prior authorizations (PA, or TAR to some) are a way insurance companies say “Sure, we’ll cover this medication if you sing us a little song, dance us a little dance, and fill out these 100000 forms”. They are of course a huge topic for venting.
Most insurances (some state ran welfare programs for examples) are kind enough to let pharmacists handle all prior auth stuff. We get to fill out the paperwork, and we sign it and send it in for review. Now you may be thinking “Why is letting you do all the work ‘kind of them’?”. Well, when the patient is calling every 20 min asking if the insurance has covered their $2000 herpes cream, you want to have control of the situation; and delegating the paperwork task to some mininimum wage twat in the doctors office doesnt really put you in control of anything; so you are at the mercy of someone who can barely hold a conversation (let alone speak english clearly). Sad, i know, but 99% of doctor submitted prior auths are from the staff, not the doctor him/herself. Which leads into my bitch for the day:
One piss-poor aspect of some private insurance’s prior auth policies is that they demand that the doctor (or their representive) submit the prior auth.. I got the pleasure of talking to an insurance rep from one of the more well-known insurance plans this last week. Heres how the conversation sorta went:
Me: “Hi! Im The Angry Pharmacist from Drugstore Z, I wish to get a prior auth for patient John Doe for some ExpensiveDrug”.
Her: “Im sorry, but the doctors office or their staff have to call”
M: “But I have the diagnosis right here, its all faxed to me, I can send you a copy if you wish”
H: “Im sorry, but we do not accept prior auths from pharmacies”
(at this point im thinking that i’ll have a good story for this website)
M: “So it can be anyone at the doctors office”
M: “Even the Janitor if he/she wishes”
H: “Uhh, I suppose so, as long as they work for the doctor”
M: “So you’ll take a prior auth from someone with zero medical experience, who is just reading scribble from the chart and has no clue what the misprounounced words coming out of their mouth mean, yet you will NOT take the same information from someone with a Doctorate of Pharmacy who went to college for 7 years who has a medical history here of all medications tried and failed, as well as the necessary diagnosis information”
M: “May I ask what qualifications do you (meaning the prior auth team, not you personally) have to take this information”
H: “We are all licensed pharmacy technicians”
M: “So, if I am not qualified to give this information, and I am a licensed pharmacist, then obvously you all are not qualified to recieve this information because you are a technician. Do you have any high-schoolers there that are qualified to take this information?”
(I actually got a chuckle out of her with that one)
H: “Is there anything else I can help you with?”
M: “You never helped me in the first place”
Now I do know of a handful of doctors offices who have competant people doing prior auth stuff, so this rant doesnt really apply to you all. Its just the 2% that take up 99% of your day that make your blood boil. Ugh.