By John Norton
Every month, the “Eye on PBMs” column in America’s Pharmacist, NCPA’s official magazine, highlights an example sent in by a reader of PBM abuse of independent community pharmacies and their patients. The following is from the November issue.
Medicine by Help Desk
“I practice in a rural independent community pharmacy that services long-term care facilities. Last fall I was processing a refill Rx for a patient for fluoxetine 20 mg. I got a rejected claim with the message for the patient to contact Caremark because refills were not allowed. I noticed we had filled this Rx for the patient a few times previously with no problem, so I called the help number listed. The Caremark representative told me that the patient was only allowed two fills at a local pharmacy and this was the third so he would have to fill at a CVS pharmacy or order by mail.
“If one searches for a CVS store by our ZIP code on our Web site, there are no matches. I told the rep that this patient was in a nursing home, and Oklahoma state law requires those Rxs to be unit-dosed. I asked if Caremark mail order would unit-dose for him. She said they would not, but he could still fill the Rx with us and submit the receipt to get up to 50 percent of the price reimbursed. This seems like an unreasonable thing to ask of someone living in a nursing home.
“Her final recommendation was to ask the prescriber to change the dose of the drug so that it would have two more local fills (since it would process as a different drug). As a health care provider, I feel this is the worst part of the story. Why would we ask to change a patient’s drug therapy based on a help desk representative’s recommendation? If we took this advice, would we just continue to change drugs and dosages every two—three months? This is not practical or beneficial pharmaceutical care. Please take these comments into consideration in the evidence against CVS/Caremark.”