Reminder: Always check prescription order date before filling

Confusion about the order date of prescriptions is causing some unauthorized prescription fills to occur. By always checking the order date of a prescription before filling it, you’ll avoid having to reimburse us for expired prescriptions.

Determining the order date

• The original order date is the date the prescription is first written or phoned in by the prescribing physician to the pharmacist.
• For electronic prescriptions, the original order date is the written date, not the transmitted date.

What’s causing the confusion
Our auditors are finding that some pharmacists use the date they originally fill the prescription as the original order date. Since patients sometimes don’t bring their prescriptions to the pharmacy immediately, we sometimes pay for prescription fills that are unauthorized as they exceed the time limit following the original order date. We’ll seek a recovery when we identify these unauthorized refills during an audit. We also don’t accept documentation to appeal this audit finding.

How to get paid
Blue Cross Blue Shield of Michigan will pay for authorized refills of prescription drugs (non-controlled substances) dispensed within one year of the original order. For controlled substances, Schedule III and IV, we’ll pay for a maximum of five authorized refills within six months of the original prescription date. Schedule II controlled substances must be filled within 90 days of the original prescription date with no refills allowed.

Because the original order date determines the life of a prescription, please be sure that:

• Refills for non-controlled substances are billed to us within one year of the date the prescriber wrote the prescription.
• Refills for Schedule III and IV controlled substances are billed to us within six months of the date the prescriber wrote the prescription.
• Schedule II drugs are billed to us within 90 days of the date the prescriber wrote the prescription. This applies to the original fill only, as refills are not permitted.