by Charles H. Karr
My doctor ordered my Synthroid as "brand name only" since Synthroid generics were known to be ineffective for many users, myself included.
In 2015, my retirement administrator contracted my SPM mail-order pharmacy program with a new provider. My doctor ordered Synthroid in the same way he ordered it from my prior pharmacies as DAW 1. This always fell within my programs with the prior pharmacy providers.
The new pharmacy charged me outside of my program throughout 2015 (for the original Synthroid prescription and 3 refills). They said my doctor didn't use the proper code. If he ordered it as a DAW 5 it would have been within my program. I didn't recognize these overcharges until I received a 2015 account summary in early 2016 for tax purposes.
When I asked for them to correct this paperwork conflict they refused and allowed a $327 overcharge to persist.
I argued, to no avail, that:
* I got the same brand name Synthroid in each order regardless of a DAW 1 or a DAW 5, at the same dose and quantity.
* At the start of 2015 I carefully reviewed each of my meds with the pharmacy and asked if there was any unique way to order Synthroid. Their agent said NO.
* The pharmacy never gave me or my doctor a heads up either in writing or verbally that Synthroid was exceptional and had to be ordered as DAW 5.
* At each order they never highlighted or notified me that my purchase was outside my program. That is, until I recognized that my contractual cap of 2015 was exceeded by $327 in 2016.
* They said they had no written dispute process, they had no written notification process for me or my doctor, and all our communications had to be verbal ("he said/she said").
* How do I recover these wrongful charges?
* What are the MD State requirements for pursuing a claim in this dispute about their negligence to inform, or in their unwillingness to correct this?
Join in and write your own page! It's easy to do. How? Simply click here to return to Questions about DAW Codes....