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Thread: prescription process- the path from the Dr to the Pharmacy

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    Default prescription process- the path from the Dr to the Pharmacy

    I hope someone knows how this works. My mind is in a fog but even with that I think the problem is not me but some system I don't understand.

    Sixteen days ago my Dr wrote a prescription for me to receive Rituxan. Apparently there is some office within the Medical Center where he works that the prescription gets sent to before it is gets submitted to the insurance company.

    He wrote the prescription but the insurance company has not received it. This of course means that I cannot begin treatment. This means that for more than two weeks I have been getting worse , without treatment. I have been through this process before with the same Doc, same medication , and the same insurance company. In the past it took two days and I was able to start treatment.

    I have been phoning the doctors office several times during the past week and they tell me things are probably slowed down due to the holidays. I cannot believe they do not have a process to get a prescription delivered to the insurance company for over two weeks 'because of the holidays'.

    Does anyone know where a prescription goes before it leaves a clinic? I want to be ready to work on this Monday when I can make some calls and find out what is going on and I would call the Medical Center office first that is sitting on this if I can figure out where to start.

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    Default Re: prescription process- the path from the Dr to the Pharmacy

    I know when we are in pain everything is magnified 100%. While reading your dilemma, the first thing I thought of was “the holidays”. Sad to say but that seems to be the world we live in today. Your orders could be just sitting on someone’s desk.
    Maybe your first phone call could be back to your doctors office to ask them the direct phone number or extension in the Medical office of where your paperwork was sent. Then call them and tell them the pain you are in and ask what could be done to fast track it. If you are getting nowhere then a personal visit may be called for. This is usually where you show up with cookies or candy and beg on bended knee.
    You also could take the route of going directly to the supervisor of the person who has this sitting on their desk. I wouldn’t be surprised if the person responsible for this is on vacation.
    Really, your story just burns me up. When I worked (and yes I will be 70 in a few weeks) clients were never treated this way.
    The buck stops somewhere. Go after it, and as a wise man once told me ‘You will catch more bees with honey.’
    Tell us what happens.
    Masha

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    Default Re: prescription process- the path from the Dr to the Pharmacy

    Those are some good ideas. Thanks for taking the time. I will let you know how it works out.

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    Default Re: prescription process- the path from the Dr to the Pharmacy

    I have often experienced the "black hole" phenomena when orders and medical info is sent from one clinic to another. It is so routine for me that now I get a paper copy of any prescriptions so I can forward it on myself or give it to another facility in person. I often ask doctors to resend things. Many times orders or prescriptions have to be sent several times before I get any action on them from some vendors for my diabetic supplies. I have found it often helps things if I can get a hard paper copy of any orders that are sent since sometimes they are needed to get the order filled.

    One time my local clinic could not find an order for a lab order that another clinic doctor had sent them even after it was sent three times. I then asked a local doctor to duplicate the order and the local lab clinic still could not find the order. A week later they found several orders for the same tests.

    My local clinic has never received any info from the clinic where I see the doctor who manages my GPA even though that clinic state such info has been sent many times. In these cases I have no idea where the problem lies, the sending clinic or the receiving clinic or in the electronic transmittal system since we know that computer systems are not perfect. I can print out the lab results but not the notes and give them to another clinic and asked them to input them manually but then the doctors at that clinic seldom know how to access or find such info so I usually bring the paper copies along to give them in person so they have my latest info.

    In a rural area it is necessary for me to use several different clinics to find appropriate specialists for my health care team and trying to coordinate the info between them is a challenge. When you add in the insurance companies and suppliers for medical supplies coordinating things is very time consuming and nearly a full time job. Some of my clinics seem to share their electronic records or use the same system where they can access each others info but my local one does not share with any others.

    I don't know how any one trying to maintain a job and family manages to do it. I am lucky I am retired and can usually find the time to make all the needed phone calls and emails and contacts on their web sites to eventually get the things done needed to manage my health care. Getting diabetic supplies is the hardest and most time consuming thing to do once you are on Medicare in the USA.
    Last edited by drz; 12-30-2019 at 10:37 PM.
    Knowledge is power! Wisdom is using it to make good decisions!

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    Default Re: prescription process- the path from the Dr to the Pharmacy

    Wow DRZ , you have truly been in the black hole.

    I had to wait another day and I'm not sure things are still straightened out yet. Of course the TELL me it is but I was also told that two weeks ago. Masha I agree with you totally about doing things in person but this facility is a long , hard full days travel away from me and honestly I just feel too sick to do it. Many days I don't feel good enough to even make calls until after noon.

    I have been getting different 'reasons' from different offices. I don't know what to believe. All I can do is keep trying and hope for the best. I appreciate you all talking to me about it and sharing experience and ideas.

    One surprising bit in this is that the insurance company has been of more help than the doctors office. One insurance person today put me on hold and called the doctors office on my behalf. Later in the day I actually got a call from the doctors office saying they were working on it.

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    Default Re: prescription process- the path from the Dr to the Pharmacy

    Patti, in Dr. VillaForte’s office has been wonderful in making sure that everything runs smoothly for me. I get the Rituximab infusion every 6 months. She sets up my appointment three months in advance and coordinates it so that I can see the Dr. first thing in the morning then go to the “chair”.
    Patti also makes sure that Medicare and my supplemental carrier have given advance approval.
    Cleveland Clinic is the best.

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    Default Re: prescription process- the path from the Dr to the Pharmacy

    @John S

    I must add a hearty Amen!!

    Happy New Year!!!
    Pete
    dx 1/11

    "Every day is a good day. Some are better than others." - unknown

    "Take your meds as directed and live your life as fully as you can." - Michael Chacey, MD

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    Default Re: prescription process- the path from the Dr to the Pharmacy

    I really hear you on being too sick to move. I have been lucky enough to have a retired husband who has made in person trips on my behalf. All you can do is keep plugging away. Let’s hope 2020 is better.
    Masha

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    Default Re: prescription process- the path from the Dr to the Pharmacy

    Quote Originally Posted by Masha View Post
    I really hear you on being too sick to move.
    Masha
    Like I told my dr.: "I must be healthy in order to be sick".
    Alysia
    dx 2008


    Here, in this forum, I have found my sweet eternal love, my beautiful Phil.. :
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    "You are my sunshine", he used to sing to me... "you make me happy, when skies are grey" I still answer him.
    Rest in Peace, my brave Batman and take care of your weggies from heaven, until we meet again.

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    Default Re: prescription process- the path from the Dr to the Pharmacy

    Interesting that no one mentioned the cost of rtx or, at least, I didn't see it mentioned. The reason I mention it is because it is semi-expensive, so I can guarantee you that it is going to get the first, second, and third degree from your insurance company before its approved and, yes, the holidays slow down everything. Its probably moving through all the wickets, but its a slow slog even during the best of times.

    My experience is that you have to be your own best advocate. Masha is right (believe it was Masha) that doing things in person is always best, but, short of that, keep good records of who you talk to, when you talked, and what they said. Eventually, you'll get to the bottom line. My guess is that it got to the insurance company, they declined the rx and wanted more justification, which took more time on your end and then it was sent back through. But, that's just a guess. Good luck!!
    Wegener's (​GPA )- dx Apr10, Granulomatous Hypophysitis - dx Apr10, Diaphragmatic Paralysis - dx Feb16, Bradycardia - dx Dec16. (my story)
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