I was talking to my service manager at the car dealership about loaner expense. He was relating stories to me on how people drop off their cars for service, get loaners and then take their time to return the loaners even after their cars are ready for pickup. I’m not talking about returning the loaner a few hours late. I’m talking about returning the loaner a few days late. And when returned, the car has 1500 or more miles on it. I was surprised to hear this. He told me that these customers drive loaner cars out of state (or wherever) for the weekend. In particular, there is more “scamming” on long weekends than any other time of the year. Eventually, the dealership had to get defensive by restricting loaner availability and raising dealer fees as their monthly car loaner costs became excessive. What is the correlation to pharmacy?

Well, in pharmacy, we have the same “milking” of the system – it’s just that the system is the insurance system. Time and again, patients present prescriptions with an incorrectly WRITTEN medication dosage versus how the physician TOLD them to use the medication. Prescriptions will be written for once daily, or twice daily only to find out that they were told take the medication half as much or half as often. By doing this, the patient gets to have a 30, 60 or 90 days of supply covered under their plan for half of their copayment. This saves them many months of copayments and doubles their supply of medication. This “strategy” to save money at the pharmacy counter is effective; however, it is not fool-proof. This deception becomes particularly interesting when the patient comes in for a refill authorization. Based on the erroneous dosing, it looks as though they were non-adherent to their dosing regimen and this triggers an insurance audit. The same applies when patients try to get medications too early and their insurance flags the record and blocks the fill.

So, who loses? Just as in the car loaner example, all patients eventually lose. We lose because insurance premiums increase to account for the fraud caused by those patients who purposely try to get something for nothing. This can only hurt all of us more as it becomes a vicious cycle of escalating costs. I’m not saying that we should police those abusing the system. What we should do is fix the dosing when we discover it, and counsel the patient about the proper use of the medication as the need arises. This way, they can understand the importance of having proper directions to follow.

Until next week, stay healthy.
Dion.