Medications Policy
Compliance: We generally do not provide medication extensions to patients after missing an appointment, or to patients that do not schedule in a timely manner. Patients should ensure that medication management appointments are made for a date that is before their next refill is due. Follow up appointments should be made immediately following each appointment. If you do not make a follow up appointment at checkout, remember to call the office to schedule as soon as possible, because your prescribing provider may be booked out for several weeks.
Refills: We do not accept refill requests from pharmacies. Medication requests must be initiated by the patient. Before calling the office with a medication request, you should call your pharmacy to make sure that your pharmacy does not have a prescription on hold that is available to be filled. Requests must be left on the Refill Message Mailbox. You will receive a return call when your provider responds to your message, generally within 48 hours.
Medication Refill fee: We reserve the right to charge an administrative fee for prescriptions requested outside of a visit. Patient must make follow up appointments within the time requested by provider following each visit (see Compliance section above). Failure to timely schedule appointments will result in a $25 refill fee.
Drug Formularies and Prior Authorizations
Drug formulary: is a list of prescription drugs, both generic and brand name, that are preferred by your health plan. Your health plan may only pay for medications that are on this "preferred" list. Our office sees patients from many health plans, and each health plan has several drug formularies. To further complicate matters, these lists are also updated several times throughout the year.
If your pharmacy informs you that a medication we prescribed is not covered, please call to inform our office immediately. Your medical provider will either choose to give an alternative medication or start the process of a prior authorization with your healthplan.
Medication Prior Authorization: is a requirement by an insurance company that your medical provider obtain approval from the health insurance plan to pay for a specific medication. It is a technique for minimizing costs, wherein benefits are only paid if the medical care has been pre-approved by the insurance company.
Patients should call NPI immediately if informed by the pharmacy that a Prior Authorization is needed. At the provider's discretion, we will either initiate a Prior Authorization request or prescribe an alternative medication. If our office initiates a Prior Authorization request, the insurer can take several days, and sometimes weeks, for a decision. In order for us to begin a Prior Authorization, the pharmacy must first receive a denial from the insurance company, after running a claim for the medication. We will not begin a Prior Authorization before the pharmacy attempts to fill the medication.