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[March 1, 2002]
Aetna Pharmacy Management is adding a new, cumulative "refill-too-soon" edit to its real-time pharmacy claim system. The "refill-too- soon" message will be received by the pharmacy when a member tries to refill a prescription before a predetermined percentage of the days supply has been used. The pharmacist will receive a message indicating that the prescription is being refilled too soon. The message will also provide the first date that the prescription is eligible to be refilled.
The online pharmacy claim system currently screens each medication-refill claim to confirm that the timing of the refill is appropriate. The parameters of this edit are set to provide a balance between appropriate utilization and member convenience. This initiative enhances Aetna's utilization and cost management efforts. In addition, medication compliance is improved and inappropriate stockpiling of medication is reduced.
How Cumulative "Refill-Too-Soon" Works
The claim adjudication system will reject a claim for a refill of a medication if less than 90% of the previous dispensing of the medication has been used in a predetermined time period; this predetermined time period is variable by plan. According to submitted days supply, if a member receives more than 450 days' worth of medication in a predetermined time period, the "refill-too-soon" edit is triggered.
If you have any questions, please call the Aetna UC Customer Service Center office at 1-800-313-3804.