UPMC still has some prescription troubles

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Stanley Burinski is among a number of UPMC Health Plan customers still having difficulty receiving pharmacy benefits this year, and he says he's tired of waiting for a fix.

"It's just been going on too long," the Rostraver resident and retired federal government employee said Thursday. Insurance company representatives told him the problem would be fixed imminently, but "[they've] been telling me that since Jan. 1."

Starting at the beginning of the year, an undisclosed percentage of UPMC Health Plan customers have been affected by a glitch preventing information in UPMC Health Plan customer databases from being properly shared with Express Scripts, the St. Louis-based company that processes UPMC Health Plan's prescription claims.

UPMC says the problem is largely on the Express Scripts side; new processing software has resulted in delays in migrating policyholder information.

"UPMC Health Plan pharmacy claims processing system converted to a new platform with Express Scripts, [which] Express Scripts implemented nationwide at the beginning of the year," said UPMC Health Plan spokeswoman Gina Pferdehirt.

An Express Scripts spokesman said that "of our 3,500 clients nationwide, about a dozen have isolated issues that we have already resolved, or will be addressed in the coming days.

The vast majority of patients we serve are receiving their prescriptions as normal."

Ms. Pferdehirt said the pharmacy issue was not a "global" problem for UPMC and, at present, affects "not more than a few thousand" customers. Many of those customers won't notice the computer problems, because the issue will be fixed before the customer fills a prescription; the bulk of the issues were resolved last week, she said, and the rest should be fixed in the near term.

For those still affected, when the customer shows up at a pharmacy to fill a new order or renew a prescription, he or she learns that a customer ID number can't be found and benefit plan details can't be retrieved.

That means the pharmacy doesn't know how much is supposed to be charged for the prescription, leaving customers to potentially pay the full list price of drugs, rather than a more affordable co-pay.

UPMC Health Plan, the insurance arm of the UPMC network, is advising affected customers to pay for the medicine with cash or credit if possible, then fill out a prescription claim reimbursement form and send in receipts -- in other words, the old-fashioned way of receiving insurance benefits, before computerization. The health plan will then issue a payment to the customer.

The UPMC Health Plan reimbursement form can be viewed and printed at http://www.upmchealthplan.com/pdf/DirectReimbursementClaim.pdf.

If customers can't pay up front for a full prescription, pharmacies are being asked to issue temporary supplies. Affected customers also can call the member services phone number found on the back of their health plan cards.

Both UPMC Health Plan and Express Scripts said it's not uncommon for health companies to have issues at the beginning of the year as new policies are put into effect, new customer rosters are sent to benefits managers and new ID cards are issued to policyholders.

Bill Toland: btoland@post-gazette.com or 412-263-2625.

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