Mail order diabetes supply requests–pay extra attention
Jayme Steig, PharmD, Pharmacy Manager
We’ve all heard stories about telemarketers taking advantage of unsuspecting individuals. PrimeWest Health has been made aware of such a situation involving diabetes supplies, and, as a result, we are asking providers to pay extra attention to mail order diabetes supply requests.
We have received several calls from members who have had issues receiving their diabetes testing supplies. These members have experienced “refill too soon” rejections at their local diabetes supply provider because a claim for diabetes testing supplies had already been submitted by an out-of-state provider (Utah in these cases).
Upon investigation, PrimeWest Health found that many of our members are receiving calls about a “diabetic survey” and are being signed up for mail order diabetes testing supply services through the “survey” process. The members affected did not realize they had signed up for the out-of-state services until they could not get their supplies through their local provider. We have learned that, after calling the member, the out-of-state company contacts the member’s primary care provider to get a valid order for supplies before sending the supplies to the member.
How can you help?
- Review order requests.
- If the request comes from a different provider than that commonly used by that member or if there is anything else that appears unusual, verify the request with the member.
- In these cases, you can also contact the Provider Contact Center at 1-866-431-0802 (toll free) to make us aware of the situation. We will conduct follow-up research as necessary.
What can members do once they have been signed up by the out-of-state company?
- Members can opt-out of that company’s services by calling the company’s customer service line.
- Members can also call PrimeWest Health Member Services at
1-866-431-0801 (toll free) for assistance.
PrimeWest Health understands that you receive many order requests daily at your offices and appreciates the extra time it may take you to carefully review order requests in light of this issue. We have made our pharmacy benefit manager, Prime Therapeutics, aware of the situation and it is investigating this concern with its audit team.