Within the past two weeks, I have witnessed pharmacists attempt to get prescriptions for Lovenox through insurance on three different occasions, for three different patients with the same astounding result. In all three cases, the insurance company would not pay for the medication unless it was put in for a longer supply. Let me explain.

In the first case, the doctor wrote the prescription for 5 pre-filled syringes of Lovenox, for a specific strength (it comes in a variety of strengths), for a 5 day supply. This is real simple - 1 syringe each day. The insurance company would not pay for the medication unless he put it in as a 7 day supply.

Does that make any sense? What happens if after 5 days the doctor decides the patient needs to continue the medication for a few more days? The insurance company would then refuse to pay for it on the grounds that it is too soon!!!

The other two cases were nearly identical, except one was a 4 day supply (insurance rep said to put it in as an 8 day supply) and a 7 day supply (insurance rep said to put it in as an 19 day supply!)

Most likely, if a refill was needed, the insurance company would require a PA (prior authorization) from the doctor. I would hope, but I wouldn’t be the least bit surprised if the insurance company refused altogether. Lovenox is expensive stuff. I guess it doesn’t matter much to them that it might save the patients life.https://danielalarcon.com/

The third happened today and the pharmacist pointed out something interesting that I hadn’t thought of. When it comes time for an insurance audit, it is highly likely that if one of these prescriptions came up in front of an auditor, they would refuse to pay for it. Get this - on the grounds that it was not run through insurance according to the doctors directions on the prescription! Even though changing the days supply is exactly what the rep required for the insurance company to pay for it! I haven’t yet seen exactly this scenario play out, but from what I have seen of insurance audits, it is certainly possible.

By the way, the insurance company in all three cases was Humana, or as I like to call them, Inhumana.
There was a recent article in the newspaper here in Sarasota Florida about the serious problem of prescription drugs being abused. It noted that the state of Florida is the highest per capita state for overdose deaths, and that Sarasota county was twice the state average. Also noteworthy was that of the 50 top oxycodone prescribing doctors, all of them were in the state of Florida.

Clearly, it is exactly because of these statistics that we have had our recent shortages of oxycodone and subsequent flood of calls looking for inventory. The DEA is not sitting still on this and most likely the state will take some actions as well. Unfortunately, as usual, legitimate customers and pharmacy personnel are caught right in the middle.
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