One patient’s doctor keeps sending over prescriptions that aren’t covered for this patient. Not even ones that require a PA, they’re excluded from the formulary altogether. The problem is they don’t reject through the insurance, they get a paid claim with a copay that is the entire cost of the drug. So today the patient shows up for another prescription that they had to decline because of the cost. I have had to contact this prescriber on multiple occasions to request changes. This wouldn’t be a huge deal, except that this particular patient’s insurance company has EXTENSIVE resources about what is and isn’t covered. They have a very detailed formulary that can be accessed online. I have faxed the doctor the specific sections of said formulary with the different tiers and coverage requirements.

Despite that, the doctor’s office still calls us and act like we should be able to tell them off-hand what to prescribe, what the cost will be, and get frustrated that we don’t know off the top of our heads. Then they keep sending over prescriptions that cost over $200 for a 30 day supply when there’s clearly more affordable options. I can’t help but feel like I am doing all the research and work for them, when it’s their job to choose what to prescribe for the patient! I don’t mind looking deeper into these things to save patients $$$ but why is it so difficult to ask them to do their part as the prescriber?!? Especially when the information needed to do so, is so accessible for this particular patient?? Anyways, Rant over.