30 or 60 day

by Kam Sessoms
(Jacksonville,FL)

If the patient had an inhaler and based on the directions it would be a 60 day supply which the insurance charges two copays. He says he can’t afford 2 copays and only wants 30 days but you can not take out from an inhaler, what do you do?

Comments for 30 or 60 day

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Apr 24, 2020
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Dont Risk an Audit from the Third Party Insurance
by: David

Hi Kam,
I understand the desire to help out someone in financial need. However, you have to balance this with the fact that if you do call the prescription a 30-day supply, you run the risk of the third-party insurance company auditing the prescription.

When this audit happens (and I have seen this type of thing in my experience) the insurance company bills the pharmacy for the reimbursement they paid previously paid the pharmacy. Insurance companies are constantly looking for ways to keep their money. If they see that you are not transmitting and billing them for the correct days supply, they will demand the reimbursement back from the pharmacy.

This is not a favorable situation for you to be in. As you may know, your pharmacy keeps track of which technician fills each prescription. And the pharmacist doesn't always look over every prescription extremely closely to check for this. Essentially, you have to make sure that you are ethically filling your prescriptions with the days supply that is accurate and not determined by the customers' ability or inability to compensate.

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