A Time to Talk: Medication refills should be simple and convenient

Mary Magee

A Time to Talk

When my elderly mother moved to an assisted living facility recently, I learned that the facility orders all of its medications from a specific local pharmacy.

Mom is covered under Medicare, but a private insurer is the supplemental insurance that covers her medications.

Soon, she received a letter from the insurance company. The letter said if she ordered her long-term medications from a local pharmacy more than three times, she would pay full price. She would forfeit medication coverage for her most important medications.

They offered an alternative. She could order all of her regular medications through mail order, for 90 days at a time, and be covered. They presented it as a simple and convenient way to get her medications.

It might seem like an easy thing to do for a younger person, but it’s not easy for an elderly person.

I am her advocate, and when I talked with the nurse at her assisted living facility about the dilemma, I was told they would have to charge a fee if we used the mail order system.

That’s because the nurses need easily dispensable medications, and the local pharmacy packages them that way for nursing homes and assisted living facilities.

The fee would cover the additional work involved in receiving and packaging 90-day supplies of her medications.

I figured the additional fee was less than the cost of paying out-of-pocket for all of her essential medications, so I spent the next several days making calls to that company. I was trying to figure out which medications had the limits and which ones didn’t.

After I figured that out, I had her doctor give me the prescriptions so I could mail order the required ones and take the others to the local pharmacy.

I went to the pharmacy and gave them the ones they could fill, explaining that I was ordering the others by mail. Then the pharmacist and I became concerned about possible gaps in her refills.

How long would it take to get the mail-order medications, and how close was she to needing refills?

At that point, I felt a headache coming on. I was frustrated with all of the complications that mom couldn’t possibly manage herself.

How was I going to make sure she got her medications in a timely manner without being financially penalized?

The solution came to me in the middle of the night. I realized I should call the pension office that buys the supplemental insurance coverage for her. Maybe they would be able to help.

The next morning, I made the call, and before I even finished explaining, the representative said, “Oh, we can get you an override for that.”

She knew how medications are packaged for use in elderly facilities and that the mail order wouldn’t work.

I was elated and relieved.

Then it occurred to me that each time I had called the insurance company, I told the technicians that mom was living in an assisted living facility. They never mentioned that there was a provision to override the mail-order rule.

Maybe they didn’t know, or maybe they didn’t want me to know.

I wonder what happens to all of the elderly people who don’t have an advocate willing to pursue questions about their medical coverage?

How many just pay the extra money because the system is too complicated, or because they don’t even realize the costs? And how much do those additional costs benefit the insurance companies?

Mom’s supplemental insurance company nearly doubled its profits in the second quarter of this year, and its CEO is nearly a billionaire.

It’s just not right.

A Time to Talk columnist Mary Magee can be reached by e-mail at marymagee@harbornet.com.