Bayside Family Practice, LLC
Easton's first Direct Primary Care!!

Prescription Refills


Prescription Policy (02/12/2010)

Due to an increase in requests for prior authorizations, requests for duplicate prescriptions, requests for unnecessary paperwork from mail-order pharmacies (PBM's)/other pharmacy plans, and requests for prescription overrides this office has instituted the following policy:

1.    If your insurance plan requires a 90 day supply you must inform the doctor during your visit prior to her writing the prescription. If you need the prescription re-written you will be required to come in for a follow-up visit and will be responsible for all co-pays etc. If you lose it or decide to mail away or change plans, you will be required to return for new prescriptions.

2.    If your insurance denies a prescription that the doctor has written you have 2 options. Pay for the prescription yourself or come back in for follow-up to discuss alternative treatment options. At the follow-up you should have already contacted your insurance company and obtained a list of medications they would be willing to pay for.

3.    Under no circumstances will the doctor call/fax your insurance company to obtain overrides/prior authorization. The purpose of prior authorizations is to deny care and save the insurance company money. We will not spend our time filling out these forms to save your insurance company money. If you decide that you want to pursue a prior authorization, then it will require an appointment and you will be responsible for the cost/copay.

4.    Medication samples are provided as a courtesy. We get very few samples but whenever possible we will try to help you. However we cannot provide you with medications on a regular basis and samples should not be expected.

5.   Our policy is that if you wish to remain on a medication you must come in for regular follow up visits. This is for your own safety as you may have been placed on a new medication or have developed a new medical problem that may prohibit the use of the medication. In addition, our malpractice insurance carrier has mandated that we not write refills without a face to face visit. Visits for unrelated problems do NOT count as an assessment of your ongoing medical issues. Physical exams and preoperative consultations are not assessments of your ongoing medical issues.

6.    Pharmacy Benefits Managers (PBM's) or “Mail Order Pharmacies”: These include Medco, Caremark etc. This practice has ethical issues with the nature of their business and the way these organizations do business (see above). Therefore, this practice will not deal with them whatsoever. This includes responding to/initiating phone calls, faxes, etc.

Please understand that our present health care system is broken and in fact is an overall mess. Your care is now being influenced and sometimes dictated by bureaucrats. It is your doctor who has your best interest in mind. YOUR INSURANCE COMPANY HAS PROFITS IN MIND. Their goal is to deny care whenever possible. The physician does not make any more money if you obtain or do not obtain the medication. THE INSURANCE COMPANY DOES. Furthermore, your health insurance policy involves a contract between yourself and/or your employer and the insurance company. The doctor's job is to select the proper medication and treatment for your medical problem. Anything that happens with respect to paying for that medication and/or treatment after you leave this office is between yourself and the insurance company. Interestingly, the insurance company will always try to shift the blame to the physician when the insurance company denies care. Remember it is you and/or your employer who are paying for the insurance and you have more leverage than you think. Both of you are going to be required to take more responsibility with respect to patient care.