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stargazer Asked January 2013

Can Assisted Living require me to use a specific pharmacy service?

My mom has been in the same AL facility for several years. I have been getting her meds from Express Scripts and giving them the bottles to dispense as directed. Now they are telling me that new New Hampshire laws starting in Feb. have put restrictions on what LNAs can do with meds and they are REQUIRING me to use their (expensive) pharmacy service that gives a prepackaged supply of dialy pills.

I can't find a reference to new laws on the web. I can't believe this is legal. Has anybody encountered this? Please HELP! I can't afford their service!

malloryg8r May 2015
KM1027, 280 Depends for around $200 is about the cheapest price that I have found. My mom uses Always, max absorb panties, I have found best online price at Walmart dot com. Used to be 20 or 30 % coupons at CVS, but I suspect they've custom -filtered my specific account to make them unavailable to me, they are never in stock (for me) anymore. I buy them in the Value Pack which is 28 panties for about $22. I don't know of any cheaper places.....sometimes you can sign up for Auto-Delivery and save 20%. But I hate those Auto-Delivery, personally, you might accumulate too much or run short. Hope you can find a good deal--maybe check Sam's Club, their house brand was priced really great. But my mom has to have the exact brand that she wants. Heaven help me if the company changes from lavender color to pink or peach, she will have a fit.

KM1027 May 2015
Yes, my husband is in assisted living and the require everyone to get their meds from an assisted living pharmacy and I get billed directly from them. Yes, it is crazy- very expensive. His meds come to about $ 200. per month.
Anyone know where you can get Depends ( or similar) cheaper than Wal Mart or Costco? My husband goes through 70 a week. My bill for Depends also runs close to $ 200. a month- all this over and above the AL fees.

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LucyLena May 2015
depends on what your STATE LAW is. I am in Alabama and they REQUIRE all meds to be bubble packed. that sounds simple rite? good luck because not many LOCAL pharmacies do that and the few that DO charge upwards of $30 per CARD per MED. and that is NOT covered by insurance, its all out of pocket. VERY FEW AL or memory care or even nursing homes allow bottle meds anymore for no other reason than its MORE INCOME FOR THE FACILITY to have their own provider and charge whatever prices they want. they will tell you it is because there is less chance of meds mixup per patient, but thats not so. clear and simple, its all always about MONEY. good luck, i have gone thru this for yrs now as Mom has gone fr AL to memory care and each place has its own rules for anything and EVERYTHING and they know you HAVE to have their services so you are stuck. there is NO CHOICE in how things are done/meds dispensed or even if the facility pharmacy CHOOSES TO ONLY USE GENERICS. i have had to insist Moms Dr specifically instruct the meds NOT BE GENERIC because Mom has had reaction to the 'fillers' used in some in the past. Good luck. really.

surprise May 2015
In a southern state; our personal care home requires them since a an aide can pas them out and a nurse is not required to be there. I tried to get any other pharmacy to do the bubble wrap deal, but none would since they also must deliver and none wanted to go this far. We've had nothing but trouble with our pharmacy billing us wrong, calling doc's refill line to get expensive meds that the doc did not want her to continue, etc. One of these caused mthr's broken arms when she was doped up on double meds when pharmacy was sending one batch for her hospice covered meds then a second using the private pay. The aids just used what was labled for her!

anonymous281963 May 2015
The rules are constantly changing, my reference is to the 2012 changes made.
Good for you for questioning this inadequate "system" and attempting to save money in this present health care crisis.

anonymous281963 May 2015
HMO also called a managed care network . Go to the admin office where your mom lives, see the regulation (must be posted by law.) I could be wrong.
The reason "they" cannot explain the rules to your satisfaction is that they don't know why or how to interpret the regulations. I am going to give you some ideas so you can seek the answers you need. The new regulations have to do with Medicaid regulations requiring all Medicaid recipients to choose from within a managed care network; and who is qualified to administer medication at the AL.
For licensing purposes, and so the LNA's can give the meds at the AL, the state regulatory agency (www.state.nj.us/health) may have required the bubble packages be administered (by the technically unqualified LNA), therefore the leap to pharmacy rules. Think of it like a hospital's requirement that you pay $$$huge amount for one tylenol so that the nurse can administer the meds, and you are not allowed to take your own.
I would try to bypass these rules, stating that you require mom's meds be administered by an R.N.
IF mom is able, can she take her own meds that you put in a 7 day minder box ahead of time?
If you are private pay, do not let them treat you under the rules required for Medicaid patients for their own convenience.

Posting this unfinished, sorry.

anonymous281963 May 2015
Even though HMO type doctors send me off to their labs, pharmacy etc. I take the written order to anywhere that is not affiliated with the HMO, and I can do that because I have "stand alone medicare"
If your mother is in a facility that is full service and you assigned her health insurance to them, their doctors, their labs, their pharmacy, then your choices may be limited, like with any HMO. Are you calling Medicare? Be sure the "laws" they are quoting are not just the policy of the facility for their convenience.

malloryg8r May 2015
Wow this all sounds tterrible. My mom is still at home and we get rx at local pharmacy in person, but I know about Express Script as that is what I use. Mom's pharmacy is not open 24/7 but I can get a very quick reply to a question. OTO, I have had trouble getting thru to ES to ask a simple question, and they are supposedly open 24/7.....I cannot imagine having to deal with the secretly-profitting organization associated with a nursing home that I'm paying $87,000 a year. Mom isn't in AL yet and we hope to avoid NH if possible. But these types of schemes do nothing to help the public trust level of these very expensive facilities. They should come clean and be very transparent of these profitable associations. It sounds illegal to me.

stargazer May 2015
I feel your pain, AnnOnymis. I was on the phone today for half an hour over the same issue I've called about at least four previous times. They were charging me for meds while my mom was in the hospital!!! They are still charging for the few meds that I get through Express Scripts, even though I've told them and told them and even made a formal list of the meds they should supply and what they should NOT and gave the list to everybody involved. I get so frustrated with all of it, if I had the room for her in my house, I think I would have taken her out of there a long time ago (and likely regretted it).

Hang in. I know how hard it is, and everybody who hasn't had someone in AL or a NH thinks that you do little to nothing because you loved one is "being taken care of." HUH!!!

AnnOnymis May 2015
Experiencing this same issue in Washington state, in fact the caregiver is national (services in more than 30 states) and it has its own pharmacy service, both of which are run as "for profit" with a presence on the stock markeet (NASDAQ) AND buy/sell recommendations AND litigation issues involving fraud markup for medicare/medicade patients who are forced to by OTC drugs from THEIR pharmacy! The bubble wrap format has changed 3 times in the past year, the kinds of generics change almost monthly, as well. My attempts to find support has been 4 hours of phone calls to "wait and hold" numbers for Washington Health Plan Information. Extremely frustrating!

OncehatedDIL Jan 2013
Possibly, someone else is working the Pharmerica "deal"? You also have to get her OTC meds through their designated pharamacy?

Your state representative's office will be able to tell you if there is such a law.

stargazer Jan 2013
ONCEHATEDIL...it's a private pharmacy in NH, not the one you mentioned. The AL/NH facility has some type of deal with them. Yes, they do the bubbles, which can only works for some meds anyway (inhaler???) and not really applicable for all the "as needed" meds she takes, most OTC.

OncehatedDIL Jan 2013
Also, call your state relresentative's office, they will know about any such laws.

OncehatedDIL Jan 2013
Stargazer, is the service they are requiring you to use called Pharmerica? Not that this could be your problem as I am not familiar with NH laws, but I ran into this problem at my IL's SNF.

Pharmerica is a part owner of their SNF and as such requires all Medicare patients to use them for drugs. I was upset as my ILs have great insurance through Express- Scripts (3 month supplies one low copay)

The business manager had us sign some Pharmerica form during admission. I tried to explain to her we wanted to use their prescription coverage, she told me MEDICARE required they use Pharmerica. Huh.

Later when I read about Pharmerica - after googling them- and receiving a $600 bill for just one of FIL's meds from them- I went to the same business manager's office as at that point no one was on Medicare, both were private pay. At this meeting she informed me that SHE had nothing to do with med ordering and I should take it up with the nurses. (?)

I transferred all of their meds from Pharmerica (who was submitting to Express -Scripts but many of the meds has been ordered for more than 3 months which ends the coverage for Pharmerica ordered meds) now all of the meds are ordered through Express-Scripts.

When I googled Pharmerica I found out this nursing home "game" of theirs is a bit shady.

Of course this may not be your problem. But, could you contact Express Scripts and see if they would package differently to be in line with supposed law?

geewiz Jan 2013
In NJ my Mom's AL has to use the bubble meds. It apparently causes fewer mix ups. But each med is separate, e.g all lipitor on one strip, vitamins on another. Ask the AL for a copy of the law so you can review it yourself. Does your Mom have a prescription plan? The reason I ask . .. . when I was helping a friend thru a final illness, she was prescribed a rather expensive drug. She had insurance, but the co-pay was still high. She called every pharmacy in her area, gave them the name/dose of the medicine and her insurance info. The least expensive? The smallest independently owned pharmacy. And it was 2 blocks from her apt. Once you get the regs, you can call around to other pharmacies to get their charges. The reality is, they are trying to make dispensing drugs error free while using the least trained person they can find. When I see my Mom getting her meds, I (occasionally) ask the LPN which med is that? They never have ANY idea. They just pop out one from each bubble wrap in that time frame! All for $87,000 a year.

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