Monday, February 29, 2016

Prescription Management

20 Feb 2016                            -5-

Our first two letters received at Provision Living at Columbia (MO) were from a pharmacy we had never heard of. Each was a bill for a drug co-payment.

The bills were repeated one month later with a suggestion that we pay them or future service may be terminated. One of the nurses in charge of pills, looked into the matter again. We found two conflicting pieces of Information:

Premier RX Health Solutions is an in-network pharmacy in St. Louis County (“If you have insurance, your co-pay will stay the same”). But our insurance summary of benefits contains: “If you reside in a long-term care facility, you pay the same as at a retail pharmacy” That is, a $10 co-pay each month, or $600/yr for five prescriptions. (This may change to 28 days, or $650/yr, in March.) A phone call to our insurance company produced other pricing that needed to be examined.

Chart 1. Schnucks Pharmacy and Premier RX Health Solutions
Then we finally get the latest (December) report from our Medicare insurance company Essence Healthcare operating as Essence Advantage (HMO) in Boone County for the fourth year (Chart 1). (Essence x Premier x PVL = unresolved as of 29 Feb 2016.)

Premier RX Health Solutions supplies drugs in bubble packs. Schnucks Pharmacy uses vials and bottles. Bubble packs save time and reduce error.

In our case, Premier RX Health Solutions did not have 134 mg fenofibrate, but did have 67 mg fenofibrate. They shipped 60 capsules instead of 30 at about the same price as Schnucks Pharmacy plus the co-pay (Chart 1).

There is a potential problem here using bottles. The nurse knows my wife gets one pill each morning. If dosage is not carefully checked she will be getting only half a dose. If the next order is sent to Schnucks Pharmacy after using the half-dose capsules, she could possibly receive a double dose. A change in an order for the convenience of the supplier becomes a threat to the health of the patient. Only a vigilant nurse can catch this when using bottles instead of bubble packs. (Actually it takes three coordinated nurses to cover a week.)

Pic 1. 800 mg/14 Tablets/$7
Another situation is an unclear posting of time so that am and pm are confused. A pill may be given (1) am, (2) pm, (3) am and pm, and (4) neither. This cannot happen with bubble packs. All pills will be in a bubble pack in March (Picture 1).

Pic 2. 200 mg/100 Tablets/$4
Even bubble packs require monitoring of prescription billing and the amount actually delivered to the residential care site and to the resident. Recommendations change (Picture 2). A Premier RX Health Solutions pharmacist periodically monitors drug usage and reports to the care site and to all the involved doctors.

After my failing back, proper medication was the next reason for moving to Provision Living at Columbia (MO) for memory care for my wife.

No more, “These are not mine. They are yours.” and “I already took those pills”. Now, a knock on the door. Pill verification. Pills in one hand, water in another, and “Here are your pills Mrs. M.” readily gets the job done. Everyone here goes by their first name.

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