Millions of seniors denied prescriptions for avoidable reasons, inspector general finds

Senior citizens are denied prescriptions millions of times each year at the pharmacy counter because the drugs are not covered by their Medicare plan, according to a report published Sept. 18 by the Office of the Inspector General.

Many of the rejections at the pharmacy counter could have been avoided if physicians were able to check their patient's plan and see the list of covered drugs as well as any prior authorization requirements before prescribing, according to the report. Many of those checks instead happen at the pharmacy counter, when it's often too late to change the prescription.

The report found that 84 million claims were rejected in 2017, which is roughly 3 percent of all pharmacy claims made under Medicare Part D, though the federal watchdog said that some of the claims may be double-counted.

In response to its findings, the Office of the Inspector General recommends improving electronic communications between plans and prescribers to reduce the number of claims rejected. It also recommends increasing audits of plans with a lot of rejections and making that information more transparent to Medicare beneficiaries.

CMS concurred with the recommendations.

Read the full report here.

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