pharmacists -- billing question

[jm1982]

I'm just trying to figure out if DH and I are going to be getting an angry phone call from Bristol-Myers in the next few days.

Here's the situation:

DH was just put on a new medication. The doc warned that some patients have had extremely high copays, so we took one of the promotional savings cards from the doctor's office. This card is only valid if you DO have insurance and if it's not through the government. The card offers $0 for the first 30 days and then $25 copays for the next 17 months, assuming your insurance copay is more than $25. I think the pharmacist is supposed to run your insurance and then put through the discount card, but I don't know how it's supposed to work for the very first month.

So we activated the card via phone after leaving the office and then went to the pharmacy. They took the card without issue and his first month's was free as it's supposed to be, BUT --

Looking at the medication receipt, it says that the amount due is $0.00 but there's a note that says: "eVoucherMsg*Not eligible; Co-pay outside threshold range," and the retail value is listed as
$700.99 for the 30 day supply. They did not run it through insurance first.

Do you think that this is an issue, and if so, should we do something or will the manufacturer likely contact the pharmacy directly? Per insurance, our regular copay for this medication is $50, so I'm thinking that the manufacturer only intends to cover the entire copay that first month, not the full cash price of the medication.

[hannamaren]

It is the pharmacy's fault if anything went wrong.
But the way you explained it, if the copay drugcocard has limitations, it wouldnt have worked.
I wouldnt worry about it. If they did it wrong and it is reversed, the phmcy will call you and they can put it through your drug plan.
But I doubt there is any issues

[noonecareswhoiam]

Copay cards are done through 3rd party vendors anyway--the drug company doesn't have your information.