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Thursday
Jun062013

Mail Order Medication Exceptions: Did you know?

 

Well I guess that you do learn something new everyday...

We are leaving for a family vacation next week so I went online and ordered a few diabetes supplies that we need for the trip. We use a mail order pharmacy and when I placed the order on their site, I was told that our insurance wouldn't allow Arden's Apidra prescription to be refilled until the 9th of June. This normally wouldn't be an issue but since we are leaving only a few days later, the insulin wouldn't arrive in time. 

So I called the 800 number and do you know what I found out?

There are exceptions that our plan allows for. I never knew before but I do now and I hope that you find out that your plans have similar fail safes built in. The best part of the exceptions? They trump insurance rules and restrictions! When the CSR tells the system to enact a restriction the order sails through the system and nothing can hold it up. Sweet!

I was told that there are three types of exceptions and that they each can be used three times a year if necessary, they are:

Emergency Exception: In case of an emergency, any emergency, I can call and have supplies sent that we require. 

Therapeutic Exception: Let's say that Arden suddenly begins to require far more insulin than she has in the past. Until I can get to her Endo and have the prescription rewritten, I just use the therapeutic exception.

Vacation Exception: Going away? Need extra stuff? Not time to refill yet? No worries... "Hello, I'm going on vacation, please send some more Apidra".

 

I hope that this information finds you well and is helpful the next time you run into a supply issue.

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Reader Comments (3)

I recently discovered this as well. I had ordered insulin pens as a back up for going on vacation. Then I went to refill my normal insulin prescription... and it was denied. I was down to maybe 1 pump refill left. So I called. They said I'm allowed 1 vacation exception per prescription a year. (I think this is because I already order for 3 months). I was happy that went a lot smoother than I was expecting!

June 6, 2013 | Unregistered CommenterMelissa

I can't believe the mail order pharmacy didn't tell you this. Every insurance is different but most still have the same basic exemptions both in the US and Canada. Every pharmacist knows that! Most of the time all we (I'm a PhC) have to do is put in an intervention code.

Enjoy your holidays :)

June 6, 2013 | Unregistered CommenterMarjorie

Great info, but sadly, for some of us who have children who have Type 1 on Medicaid programs, there are no exceptions to the rules. These are all private insurance exceptions. I have tried everything in the book to get extra insulin for trips, get emergency supplies, and I have gotten nowhere over the past 4 years with PA Medicaid. And that, my friends, is why we still need insurance reform in this country.

June 6, 2013 | Unregistered CommenterPenny

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