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Pacificcare insurance Complaint - Beware of Pacific Care

Review by tony1111 on 2010-03-29
I was reading some of the other negative review about pacificare, which processes multiple Medicare-D plans including AARP and Secure Horizons and thought as a pharmacist I would give people a warning. I have never dealt with an insurer who cares less about their members. They are the only insurer who will not overide prescriptions for early refills even in the event of dose increases or vacations. They are the only insurer I have every seen charge non formulary co-pays on generics. ie $43 or more for a generic. And my last point the are terrible with prior authorization. (if the do not cover a drug the md can apply for an exception) which pacificare commonly denies. Humana, Wellcare, Advantra rx, Cigna are all decent national plans but buyer beware if you decide to use any of the pacificare plans.
Comments:2 Replies - Latest reply on 2010-03-29
Posted by Anonymous on 2010-03-29:
All plans are not created equally. It depends on the amount of coverage the employer provides and is willing to pay for that determines the copay amounts. This is true for all prescription drug plans. Not just PacifiCare. Regarding patients on AARP plans, all MediCare Part D plans must be reviewed and approved by CMS and they cannot be changed again until the following year.

As a pharmacist you should already know that there are issues across the board for all insurance companies. You know that there are state guidelines that require how quickly plans must respond to requests for prior authorization of medications. This is also (I believe) governed by ERISA guidelines as far as first and second level appeals and when they must go to an IRO. There are also guidelines for urgent prior authorizations.

Having previously worked in retail pharmacy for over 12 years I can say without any doubt that PacifiCare does give early refills when a dosage is changed. Example, they may not approve taking two of the 5mg tablets to equal 10mg, but they will approve the 10mg tablet moving forward. This is standard policy for most if not all of the insurance companies.

Posted by Anonymous on 2010-03-29:
As a Pharmacist you should know that insurance companies are about coverage and profit, not emotions.

"(if the do not cover a drug the md can apply for an exception) which pacificare commonly denies." That is their right. if they do not cover it in the first place, there is no law that says they have to make an exception.

"They are the only insurer who will not overide prescriptions for early refills even in the event of dose increases or vacations." Again, they do not have to. Patients who need more from their insurance should either upgrade their plan, or find a new one.

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