Pharmacy Pitfalls

Pharmacy Pitfalls

Often our children receive prescriptions from a doctor, ER or hospital and they are denied at the pharmacy. It’s VERY important to contact your WATCH RN whenever you encounter a problem. However, here are a few tips to PREVENT issues:

·         Before leaving the doctor’s office or hospital, ask the nurse or doctor if the medication is generally covered by your insurance. If not, ask them if they can prescribe a similar drug that is covered

·         Ask the doctor or hospital if they can call the drug into the pharmacy before you leave

·         If it’s a medication that needs compounding (or it’s a specialty medication), make sure the pharmacy carries the medication

·         Make sure your pharmacy has the correct insurance information

·         Keep your insurance company’s Pharmacy Department information handy (i.e. Sunshine uses US Script: 800-460-8988 BIN# 008019)

If you follow the above steps &

the medication is still denied

·         Ask the pharmacy to call the Medicaid help desk and/or your insurance’s pharmacy department

·         If the medication is rejected due to wrong dosage orders, ask the pharmacist to call the doctor’s office while you wait

·         If the medication is rejected due to needing prior authorization from your doctor, ask when and if this can be accomplished

·         CALL YOUR WATCH NURSE, your assigned Sunshine RN Case Manager or your insurance company nurse help line (ex. Sunshine: 866-796-0530)

WATCH Nurse Contact Information:Melanie Simmons - Manatee (941)721-7670 X 102Liz Harris - Sarasota/DeSoto @Northgate (941)371-4799 X 145