Refill Too Soon Insurance Rejections

This page discusses refill too soon insurance rejections that are often encountered when filling refill or new prescriptions.

It also discusses how to override this rejection with a few of the frequently used insurance companies.

Insurance companies will usually allow a refill on a prescription once approximately 75% of the previous fill has been used up.

This is typically close to 7 days early on a fill of a 30-day supply of a medication. On a 90-day supply, usually insurance companies will allow the prescription filled 21 days early.

Some insurance companies allow pharmacy staff to enter an override code, indicating that there was a need for either a vacation override or dosage increase override.

The Medco insurance plan allows for this, as well as Medco Part D plans.

Other insurance companies, like Wellpoint Next Rx, allow for an automated phone override.

A pharmacy employee brings up the insurance rejection on their computer screen and calls Wellpoint's 1-800 number. Then the employee chooses the Refill-Too-Soon option, and enters the pharmacies NABP number and the prescription number that was rejected.

Wellpoint will then find the prescription in their database. The pharmacy employee then indicates the reason for the early refill, and Wellpoint will decide to approve or deny the refill.

The pharmacy employee then can reprocess the claim and receive a paid claim if the override is approved.

Other insurance companies may require the pharmacy employee to speak with an insurance representative on the phone in order for them to approve the override.

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Some of the Topics Addressed:

Refill Too Soon Rejections

  • Vacation Override?
  • Dosage Change Override?
  • Lost/Stolen/Damaged Override?

DUR Rejections

  • DUR stands for Drug Utilization Review
  • How to successfully resolve this rejection
  • Nearly ALL? possible DUR Codes (BONUS)

Prior Authorization (PA) Rejections

  • Why do PA's Happen?
  • How long do PA's take to get resolved?
  • Typical Procedure for Handling a PA

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