This occurs because skilled nursing facilities and some assisted living communities receive their medications on a monthly basis, true to the calendar month. So we bill for a partial supply upon admission of the resident to the facility, and then bill for a month's supply of all prescriptions prior to the following month, in anticipation of it's delivery to the facility prior to the first. For example, if you or your loved one is admitted on the July 16th, we would have to supply medications sufficient for all med-passes that take place from the time of their admit, through July 31st. Those odd quantities would constitute one billing on the statement, and the quantities we'll supply for the following month would constitute another.
The most common mistake we encounter in the pharmacy is either not being supplied with prescription drug insurance at the point of resident admittance to the nursing facility, or being supplied with the incorrect insurance, i.e. the medical card, dental card, or Medicare Part A/B (Red, White & Blue Card) which doesn't cover prescription drugs. If we do not have this at the point of admittance, we still have to supply the medications, otherwise the nursing facility cannot uphold their obligation to provide patient care and pass medications. So we're in a tough spot, and most commonly neither the newly admitted resident nor a power of attorney or other responsible individual is available to provide us with the necessary information. If we do not receive the information we need, a billing statement will still be generated.
Usually. Most insurances let us bill them retroactively up to 90 days, others longer. We will do everything we can to get you maximum value from your prescription insurance, and credit you the difference on claims we've been able to re-bill retroactively.
Prescription insurances have formulary committees that make decisions as to what medications to cover, and what medications to not cover. There are a multitude of factors involved, including therapeutic effectiveness, cost, availability over-the-counter, availability of substantially more economical therapeutic equivalents, etc. For specific information, or to request a coverage determination from your prescription insurance, we encourage you to contact them for their specific policies, we have no access to this information.
Most commonly, over-the-counter products are not covered, such as Docusate Sodium, Acetaminophen, Ibuprofen, vitamin and mineral supplements including Calcium and Vitamin D. Other times, some prescription products are not covered, and usually in the case of seniors, prescription insurances will elect to not cover a medication if there are documented negative outcomes associated with use of the medication. Other reasons exist as well, such as a lack of effectiveness, cost related issues, etc. For specific information about your prescription insurance's medication formulary, please contact them.
No. There is no additional cost to you. The pharmacy is reimbursed the same in skilled nursing settings.