Prescriptions

We only prepare prescriptions during an office visit. Please help us make the most efficient use of your time and healthcare dollars by reviewing and following the suggestions below.

  • Keep a current, accurate list of your medicines.  When you are in the office, we will give you a list of your medications and how you are taking them.  Keep your list up-to-date between visits by adding or crossing out medications that our physicians or other physicians change between your visits with us.  Bring your medication bottles and list to every office visit.  We can better track your refill needs if you bring your bottles.
  • Request a copy of your insurance company’s drug formulary and bring this with you to each office visit.  The physician can use this to prescribe according to your insurance plan’s guidelines and restrictions for covered medications.
  • During your office visit, we will write your prescriptions with adequate refills to last until we need to see you again to re-evaluate your health status.  We will also inform you of when we need to see you again to re-evaluate your health status.
  • We will send prescriptions directly to local pharmacies.  You will be given prescriptions for mailing to mail-order pharmacies.  Mail-order drugs are dispensed with a 90-day supply.
  • If you use a mail order drug company, we recommend that you send prescriptions by certified mail with a receipt requested.  We also recommend that you make a copy of your prescriptions before mailing in the event the mail order company loses your request.
  • We are unable to respond to fax communications from your mail order company.

Diabetic Supplies by Mail  Order

Many companies provide diabetic supplies. We will give you prescriptions for your medical supplies when you are in the office for diabetes education and care. You can then provide the prescriptions to the company of your choice.

Often diabetic supply companies try to communicate with the physician’s office rather than with you, their client.  They may send several fax communications to our office asking approval to send you the same order of supplies.  This results in you receiving, and you or your insurance company paying for, more supplies than are necessary at one time.

To eliminate the possibility of duplicate refill approvals and additional out-of-pocket expense for diabetic supplies, we do not respond to any fax communications or phone calls from any of the supply companies. This will help us keep accurate records of your prescriptions and prescription renewals for diabetic supplies

Insurance Prior Authorizations (PAs) for Non-Formulary Medications

Many insurance companies have new rules for prescription payment. These new rules are intended to reduce your insurance company’s expense for medications, but these cost saving measures have resulted in added employee expense for physician offices.

Insurance companies negotiate prices for medications with pharmacies. The medications with the lowest negotiated prices are placed on the insurance company’s “formulary” and these are the medications that your plan wants your physician to prescribe. If your physician prescribes a medication that is not on your insurance company’s formulary, your insurance company may require that you:

  • first try the drug on the formulary or

  • obtain a prior authorization (PA) for the non-formulary medication or

  • pay for the medication out of your pocket.

Obtaining a PA requires clinical conversations among the physician’s staff, the pharmacy and your insurance company. The time required to obtain a PA ranges from 30 minutes to two hours.  Depending on the timeliness of the information return from the insurance companies, it may take a month to complete the information exchange required for the PA. Upon completion of the clinical information exchange, there is no guarantee that the insurance company will approve coverage for the requested medication.

To cover the added cost of this insurance company demand, we charge $15 for each medication PA the staff attempts to obtain for you.The insurance company will not pay this charge and it will be a direct cost to you.

We understand if you do not want to pay for obtaining a PA for a medication not on your company’s formulary.  In these situations, your physician will prescribe a medication that is on your formulary. Drug formularies differ with each insurance plan and are changed frequently. You will need to bring your current drug formulary to each office visit. By bringing your insurance plan’s formulary to every office visit, you and your physician can work together to minimize your medication expense.
 
   



      

 
 
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