Q. What do I need to do to start Service with Complete Pharmacy Care?

  • Complete a Demographics/Face sheet (Name of Client, DOB, SSN, Diagnosis, Allergies, Address, Phone Number, & Insurance information)
  • Acquire valid prescription information or the name and number of the pharmacy to get medications transferred in
  • Have a signed HIPPA & Assignment of Benefits
  • Decide the best method for medication packaging (Blister, Bottle or Fastpak)

Q. I have a prescription at another pharmacy, can you get it or do I have to get a new prescription?

As long as there are valid refills we can transfer the prescription to our pharmacy.

  • We will need to know the name and strength of the drug
  • We will need the previous pharmacy's name and telephone number
  • It is also helpful if you have the prescription number

Q. What is cycle filling and calendar day dispensing?

Cycle filling means that as long as there is a valid prescription, Complete Pharmacy Care will automatically fill and ship routine medications monthly. This helps alleviate having to remember to call and request medications to be sent and continue prescriptions without a break in therapy.

Calendar day dispensing means that the dispensing is based off of the calendar month. When a month has 31 days, Complete Pharmacy Care will dispense 31 day supply of medication, whereas other pharmacies would only dispense 30.

Q. How do I use the blister card packaging?

With the calendar day dispensing, caregivers should dispense the corresponding date of the month on the blister card. The blister cards have 31 slots to accommodate the days of the month.

For example, if the start date of the medication is the 11th, then on the 11th of the month, the medication in the 11th slot on the blister card should be given on that day.

Q. What is short filling?

Short filling is when we fill medication according to the on hand amounts of a medication according to count sheets of each individual's medications that are dispensed, in order to get that prescription to the correct cycle start date.

Q. What are the legal requirements for a controlled substance III-V prescription?

A prescription for a controlled substance must be dated and signed by the practitioner, on the date when issued. The prescription must include the patient's full name and address, and the practitioner's full name, address, and DEA registration number. The pharmacy can accept verbal refill authorizations from the practitioner or an employee of the practitioner who is designated to give verbal refill authorizations. The prescription must also include:

  • Drug name
  • Strength
  • Dosage form
  • Quantity prescribed (written numerically and as a word)
  • Directions for use
  • Number of refills authorized (if any)

Q. Can I fax my CII prescription to the pharmacy?

Yes, CII prescriptions can now be transmitted electronically. An original CII prescription must be mailed to the pharmacy before the medication is dispensed. Practitioners prescribing schedule II controlled substances for residents of long-term care facilities may transmit a prescription, via fax, to the dispensing pharmacy with the words "Long-Term Care Facility" written across the top of the prescription. The facsimile prescription serves as the original written prescription for the pharmacy and the practitioner must keep the original copy of the CII prescription in the patient's records. Refills are not allowed on CII prescriptions.

Q. If it's after 5pm or the weekend, and I need a medication or a new medication that was ordered, who do I contact to get this?

We have a pharmacist on call 24/7 that can assist you with receiving the medication if it's after hours or the weekend.

Q. What is an Order Issue List (OIL)?

This is a document that Complete Pharmacy Care provides ICF and HCS facilities to better prepare for the upcoming month medication cycle for their clients.

This report provides information about prescriptions needing attention to forgo a break in therapy, like pending prior authorizations, expired prescriptions and other valuable material.

Q. What is a prior authorization?

A prior authorization or PA occurs when an insurance company will not pay for a prescribed medication until the physician calls the insurance company on behalf of their patient.

Q. What medicines require a prior authorization?

  • Brand name medicines that have a generic available. A generic medicine is a medicine that contains the same active ingredient as the brand name drug, but is available at a lower cost.
  • Expensive medicines.
  • Medicines with age limits. Retin-A®, a topical acne treatment, is an example. Acne is considered to be a condition of children and young adults. Retin-A® may not be covered if the person is over a certain age. This age can vary and is usually determined by the insurance company.
  • Medications typically not prescribed for a particular gender.
  • Drugs used for cosmetic reasons. For example, Propecia®, which is prescribed to re-grow hair or to prevent hair loss.
  • Drugs prescribed to treat a non-life threatening medical condition. These drugs are usually not needed to maintain life. An example is erectile dysfunction drugs such as Cialis®.
  • Drugs not usually covered by the insurance company, but said to be medically necessary by the doctor. Many different drugs can be used to treat the same condition. If a patient requires a particular medicine, the doctor must inform the insurance company that the specified medication is the only working option for the patient.
  • Drugs that are usually covered by the insurance company, but are being used at a dose higher than "normal".
  • Questionable indication, where the physician prescribed the medication for a different indication than what the drug is normally intended for.

Q. What should I expect if a medication needs a prior authorization?

If an insurance company requires a prior authorization on a medication, it usually means the insurance company needs more information from the physician before the insurance company can decide if they will pay for it.

But beware, not all medicines will be approved. Even if everything is completed by the physician correctly, the insurance company may still refuse to cover your medicine. In the end, the insurance company is the one making the decision.

Q. What should I do if my medicine needs a prior authorization?

If Complete Pharmacy Care informs you that a medicine requires a prior authorization then you should:

  • Contact the doctor who prescribed the medicine and let them know that your medicine requires a prior authorization.
  • Ask your doctor how long it usually takes for them to contact the insurance company and fill out the appropriate forms.
  • Contact your insurance company and make sure there are not any additional steps you need to take. Your insurance company may require paperwork or signed forms before proceeding with a prior authorization.
  • Allow the doctor's office and insurance company enough time to complete their end of the process.
  • Check back with the pharmacy to see if the prior authorization was approved.
  • If your medicine is not approved, call your insurance company and find out why.

Q. What are some of the reasons why a prior authorization may not be approved?

  • Your insurance denied your prior authorization claim.
  • Your doctor's office forgot to contact your insurance company.

Q. Why does a prescription say it needs a prior authorization, when one was already received?

The prior authorization process needs to be renewed each year, and/or possibly every month depending on your insurance company and formulary changes.

Q. When will I receive my invoices?

Invoices are created, printed and mailed out at the beginning of each month for the previous month's medication. You should receive your invoices no more than two weeks after they are created.

Q. Can I receive my invoices through email or fax?

Yes, you can receive your invoices through email or fax. To change your billing setup, please contact our billing department.

Q. How can I pay my invoices or outstanding balances?

We have two ways for you to pay your invoices. You may send a check in the mail with the top part of your invoice, or you may call in with a credit card.

Q. How will you know where to apply my payment if I send in a check?

When paying by check, please send and attach the top part of the invoice with your payment. The bottom part of the invoice is for your records.

Q. Why am I being billed for RX's and OTC's?

Any RX's or OTC's are billed privately to the patient when insurance coverage does not cover the medication. Medications are also billed to a client when they do not have an active insurance plan. Also, a client is responsible for co-pays designated by their insurance plan.

Q. I received a Billing Authorization, what do I need to do with it?

A billing authorization is an agreement to pay for medication. A billing authorization is sent with a reason as to why a medication would not be paid by a client's insurance coverage or if a medication is paid by an insurance coverage, but has a high co-pay amount. If a medication is not covered by insurance, we send authorizations to patients and facilities to make them aware of the non-coverage.

  • If the medicine is needed and the facility or client agrees to pay the amount given, then check the box to authorize, sign the bottom line, and send it back via fax or email.
  • If the medicine is not needed or cannot be paid for by the facility or client, then check the do not authorize box, sign the bottom line, and send it back via fax or email.

Q. What if I have questions about my bill?

If you have any questions about the charges on your bill you can call the pharmacy and ask to speak with the billing department. They will be happy to answer any questions.