Magazine article Drug Topics


Magazine article Drug Topics


Article excerpt

Uniform card badly needed

In reference to your article on uniform Rx benefit cards (Drug Topics, July 19), I have actually had this conversation:

PBM Help Desk: "Hello, can I help you?"

Me: "I'd like to check an eligibility."

PBM: "ID number, please?"

Me: "123-45-6789."

PBM: "Jane Doe. Eligible."

Me: "But I'm getting a rejection."

PBM: "What's the group number?"

Me: "56781234."

PBM: "It can't be that."

Me: "That's what the card says. Under 'Group Number."'

PBM: "You don't use that number."

Me: "What number do I use?"

PBM (sighing): "I'll check the records. Please hold."

PBM (after an interval): "94375."

Me: "That doesn't appear anywhere on the card."

PBM: "Well, that's the number you have to use."

Me: "But how do I know that?"

PBM: "Well, that's this person's group number. That's the number you have to use. You don't use the group number that says 'Group Number.' You use the *GROUP* number."

A uniform standard for the format of PBM cards is absolutely necessary. We need to know exactly what to input for the ID number, including prefixes and suffixes, hyphens, appended member numbers, and so on, and what to input for a group number, and which "group number" is the pharmacy benefit group number (for which PBMs have all manner of names). The card should also indicate the name, member number, status, and date of birth of all eligible members. How many parents carry their children's cards? Yeah, right.

Steven H. Mesnick, R.Ph.

Cranston, R. …

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