Life of a pharmacy technician: How to deal with frustrating customers - what they’re really thinking

Summary

The conversation revolves around the coverage of Lidoderm 5% patches under Medicaid. The individual learns that Medicaid does not cover the patches without prior authorization from a primary care doctor. Despite previous experiences with different Medicaid plans, the current straight Medicaid plan requires a new prescription and authorization. The person is confused as they have successfully obtained the patches at Wegmans pharmacy without prior authorization before, but now faces a claim rejection. The dilemma is whether to hold off on the patches or seek further clarification on Medicaid coverage.

Takeaways

• 💊 Lidoderm 5% patches require prior authorization from a primary care doctor, and Medicaid does not cover them without it.
• 🏥 Emergency room doctors do not handle prior authorizations for prescriptions.
• 📝 The prescription for amoxicillin, an antibiotic, was processed without issue.
• 💸 The cost for 10 Lidoderm patches is $101.87.
• 🔢 The prescription is written for 10 patches, not 30, despite the user's claim of previous 30-patch prescriptions.
• 📍 The user is in Helenair, NY, and is dealing with what they believe to be 'straight Medicaid'.
• 🤔 There is confusion regarding whether the user's previous Medicaid plan covered Lidoderm patches without prior authorization.
• 🛑 The user has been able to purchase Lidoderm patches with Medicaid coverage in the past, but the current situation is different.
• 🏢 The user purchased the patches at Wegmans pharmacy without prior authorization, which contradicts the current claim that it's not covered.
• 🤷‍♂️ There is uncertainty about whether the previous coverage was due to a managed care Medicaid plan versus straight Medicaid.
• 😣 The user is distressed because without Medicaid coverage for the Lidoderm patches, they cannot afford the medication for their pain.

Q & A

Are Lidoderm 5% patches covered by Medicaid?

The script suggests that Lidoderm 5% patches are not covered by Medicaid without prior authorization from a primary care doctor.

What is the role of a primary care doctor in getting Lidoderm patches covered by Medicaid?

The primary care doctor needs to write a new prescription and obtain prior authorization for the Lidoderm patches.

What is the cost of Lidoderm 5% patches mentioned in the script?

The cost mentioned for 10 patches of Lidoderm 5% is $101.87.

Why was the prescription for Lidoderm patches written for only 10 instead of 30?

The emergency room doctor and nurse mentioned writing it for 30, but the actual prescription was for 10 patches, possibly due to a misunderstanding or error.

What is the difference between straight Medicaid and a managed care Medicaid plan?

Straight Medicaid is the basic program, while a managed care plan is a type of Medicaid that involves a network of healthcare providers and may have different coverage rules.

Why might the user have been able to get Lidoderm patches covered by Medicaid in the past without prior authorization?

The user may have been using a different Medicaid plan, such as a managed care plan, which had different coverage rules and may have covered the patches without prior authorization.

What is the user's current location?

The user is currently in Helenair, NY.

How did the user get Lidoderm patches covered at another pharmacy without prior authorization?

The user got the patches covered at Wegmans pharmacy, but the script does not provide a clear explanation for why prior authorization was not required in that instance.

What was the user's experience with getting antibiotics covered by Medicaid?

The user's experience with getting antibiotics, specifically amoxicillin, was smooth and without issues.

What is the user's concern regarding the inability to get Lidoderm patches covered by Medicaid?

The user is concerned because they have been able to get the patches covered by Medicaid in the past and now face a potential inability to get the medication for their pain.

What action is the user considering if Medicaid does not cover the Lidoderm patches this time?

If Medicaid does not cover the patches, the user implies they may not be able to afford the medication and would have to forgo it.