Recently Accurate Rx received a referral for a patient with hemophilia. This patient had a benefit for his anti-hemophilic factor medication on both the medical and pharmacy benefit.
His previous pharmacy only had experience with billing the pharmacy benefit. The pharmacy benefit management (PBM) company had suddenly blocked the pharmacy from submitting any more claims for the medication. The pharmacy then told the patient and the referring physician that they could no longer provide medication for the patient. Unfortunately, the patient was still dosing after a procedure on his knee and needed his medication.
The Hemophilia Treatment Center physician called Accurate Rx Pharmacy to see if our team could provide medication for the patient. Our team went into action and received an authorization on the medical side of the patient’s benefits to provide him medication for the remainder of his post-op therapy. Since he recently had a surgery, his out-of-pocket cost had been met.
The bottom line is that the patient received medication from Accurate Rx Pharmacy on Thanksgiving Day and until the end of the year, utilizing the patient’s medical benefit. We re-evaluated his benefits at the beginning of the new-year and discovered that it would be more beneficial for him financially to receive his medication through the PBM-owned pharmacy. Accurate Rx Pharmacy remains available to take on infusion nursing as needed. We will always be a resource for this patient’s educational needs. Additionally, Accurate Rx will be there if his deductible on his medical benefit is met and he would prefer to obtain medication from our dedicated team.
At Accurate Rx Pharmacy we have a greater than 95% success rate when it comes to working with insurance to provide in-network care for patients with bleeding disorders. Please contact us today to see how we can be a member of your team!