Case Study: Neighborhood Pharmacy Versus Mail Order Pharmacy
Rishi Sardana is an 11-year-old boy who is being switched from regular Ritalin to Ritalin LA, the long-acting version. His father, Mr. Sardana, goes to the pharmacy to pick up the new prescription, but he is told that the insurance company is refusing to pay for the LA preparation. The upset father tells the pharmacy technician that the pharmacy did not do it right and he wanted the pharmacy to fix the problem. The pharmacy technician calls the insurance company to clarify why they do not want to pay for the LA preparation. The representative of the insurance company explains that Ritalin LA is a maintenance drug and the policy of the insurance is that maintenance drugs must be ordered through their mail order pharmacy program. The representative also explains that they sent information to the family about how to make the switch. The insurance company does agree to approve the drug at the pharmacy, but with a much higher copay. The patient decides to buy a 30-day supply at the pharmacy and then transfer the prescription to the mail order pharmacy program, which has a much smaller copay.
Discussion Questions
- Identify the members of the team mentioned in this case study.
- Discuss the responsibility of each team member for the failure in communication. Remember the patient is also part of the team.
- Should the insurance company be part of the healthcare team? Explain your rationale.
- The insurance company sent information to the Sardana family about changing Rishi’s prescription to the mail pharmacy. The communication of the health insurance company was not effective. If the team members involved in this case were working in collaboration, what other measures may they have taken to ensure the communication of this information was successful?
Case Study: Neighborhood Pharmacy Versus Mail Order Pharmacy
Rishi Sardana is an 11-year-old boy who is being switched from regular Ritalin to Ritalin LA, the long-acting version. His father, Mr. Sardana, goes to the pharmacy to pick up the new prescription, but he is told that the insurance company is refusing to pay for the LA preparation. The upset father tells the pharmacy technician that the pharmacy did not do it right and he wanted the pharmacy to fix the problem. The pharmacy technician calls the insurance company to clarify why they do not want to pay for the LA preparation. The representative of the insurance company explains that Ritalin LA is a maintenance drug and the policy of the insurance is that maintenance drugs must be ordered through their mail order pharmacy program. The representative also explains that they sent information to the family about how to make the switch. The insurance company does agree to approve the drug at the pharmacy, but with a much higher copay. The patient decides to buy a 30-day supply at the pharmacy and then transfer the prescription to the mail order pharmacy program, which has a much smaller copay.
Discussion Questions
- Identify the members of the team mentioned in this case study.
- Discuss the responsibility of each team member for the failure in communication. Remember the patient is also part of the team.
- Should the insurance company be part of the healthcare team? Explain your rationale.
- The insurance company sent information to the Sardana family about changing Rishi’s prescription to the mail pharmacy. The communication of the health insurance company was not effective. If the team members involved in this case were working in collaboration, what other measures may they have taken to ensure the communication of this information was successful?