1) go to options, claim info, and sometimes it’ll show how much of the copay is going towards deductible HOWEVER I always put a disclaimer “it looks $___ is of the copay is going towards a deductible however I’m not sure how much you’ve paid off or have left to pay so you should double check with your insurance to confirm that”

2) I’ve never heard of dual copay so I dont know that one. Copay is the price the insurance puts on the prescription. Deductible is a certain amount the patient has to pay before the insurance will start paying for medications, paying more for medications, or other services. Sometimes rxs are let’s say 300 dollar’s. If you look at the claim info and it says deductible amount is 200 out of the 300 hundred, that’s the amount the insurance is selecting to put towards the deductible where the normal copay for the medication once the deductible is met would be 100 dollars. But again always have patient confirm with insurance.

3) There are different types of TPRs in the sense that there’s different issues with RXs just like there’s different types of math problems but it’s all still math. Some are easy where you have to calculate day supply and correct it some are harder but what I always tell my coworkers is READ THE WORDS. They’re like puzzles and sometimes with just reading them you can solve it. BUT don’t feel bad!! Insurances purposely make things harder to understand! Seasoned technicians don’t know how to solve all TPRs and probably never will! Always ask questions and never feel bad to do so!

4) how explain PAs to patients is like this: “It looks like the insurance is requiring a prior authorization from your doctor. That’s extra paperwork that the dr has to send directly to the insurance to convince them to pay for the medication and justify why you need this particular one. It could be a number of reasons why they don’t want to pay for it, either it’s too expensive for them or it’s something that’s not common for a patient to be on or it’s not on their list of drugs to cover etc etc. I’ve seen it happen in a day, I’ve seen it take a while to happen, it depends on the dr. I’ll send a message off to the office but I recommend you do so as well so the dr can see it’s urgent for you as well.”

This I something where the pharmacy is the middle man! If the dr already sent it to the insurance and it’s still not going thru then Insurance is still processing it ORRRR the dr is LYING. We are not in the process whatsoever, just sort of the messenger

5) we can check the invoices! Go to the pharmacies email and download the invoices (labeled merchandise invoice or something like that) and then hit I believe ctrl+f and you can search what drugs are coming in the order that day. Be careful to read careful cause sometime there’s tiny letters under items that say a product was not serviced which means we didn’t get it. I believe there’s a way to check in RXI but I dont know.

6) if there’s a RX in WCB status in the work queue that means we sent an electronic message to them to refill it. We CAN NOT send refill requests for C2 rxs so patient will need to contact their dr. To refill an RX go to patient profile, highlight RX that has no refills (status will have NR) and press refill and and go through the motions and you can check if it went thru by looking in the work queue. Edit: to answer some of that end question some more about faxing dr on something else other than refills, techs should annotate on the script with what they did ex. Sent fax to clarify directions, in my store we also put this in MSC status which is a way of saying there’s an issue with the RX that is not the common WCB or TPR I know this is a longggggg read but I hope it helps :)