Ask the Advisor: August 2016

Ask the Advisor: August 2016

By Mary Johnson, editor

I Did Not Order This Prescription.  Do I Have To Pay For It?

Q: My doctor recently changed one of my prescriptions and faxed a new one in to my health plan’s mail order pharmacy.  I received it few days later.  Since the old prescription was expiring, I didn’t think I would have to do anything to stop that prescription.  Wrong.  I wound up with a new shipment of my former prescription a few days later.   When I called I was told the prescription was filled correctly and I could not return the unused meds once shipped.  Is this legit?

A:  Unfortunately this is happening too often, and it’s hard to fight.  The high level of automation in mail order pharmacy systems can lead to the mail order pharmacy auto-renewing prescriptions without confirming that you are still taking the medication or if your dosage has changed.  When this occurs, you could be sent the meds, and then billed for the meds unless you contact the pharmacy IN ADVANCE of the shipment.

I reviewed a sample of 1,200 complaints relating to mail order pharmacies, received by the Centers for Medicare and Medicaid Services (CMS) from January 1, 2013 to September 16, 2013.  Unwanted mail order shipments are the top complaint.  The criteria used to resolve disputes hinges on whether the mail order pharmacy made an error in filling the prescription, which is something that can be hard for consumers to prove.

Problems arise when consumers fail to understand how the automated mail order pharmacy system works and what actions they need to take when prescription changes occur.  For example, many mail order pharmacies, (except for Medicare Part D plans) do not call customers to verify that prescriptions are wanted or to advise of costs.  If you get your prescription coverage through a Medicare Advantage plan, an employer health plan or a healthcare exchange plan, you need to be careful about choosing mail order and you need to learn whether the plan will notify you to verify prescription orders and costs.

To learn more about ways to prevent unwanted mail order drug shipments, click here to read the article “Avoid Problems With Mail Order Pharmacies”.