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Refill problems dog Family Care HMO says it's trying to fix glitches in its online prescription system By SUSAN JAY Jackson County residents covered by Family Care are still having problems refilling their prescriptions, but officials with the HMO said they have taken steps to correct problems with their online prescription system. Family Care, the HMO for more than 8,500 low-income Jackson County residents on the Oregon Health Plan, started using new drug guidelines in September to curb costs and the abuse of narcotics. The HMO now requires pre-authorization for refills of pain medications and muscle relaxants statewide, as well as for a broad list of drugs for their members in Jackson County. These steps were taken locally, company officials said, because the HMO has been losing money in Jackson County. Family Care is negotiating with PrimeCare, which represents more than 300 doctors in the valley, to see if the HMO will remain in the county. When the new drug guidelines were implemented on Sept. 15, many Family Care members were unable to refill their prescriptions. That was not supposed to happen, the company's chief executive said Monday. "All we know is that whatever system was in place wasn't working and it needed to be changed," said Jeff Heatherington, Family Care CEO. "The pharmacists were running into multiple roadblocks that weren't intended." Heatherington said Family Care has worked with Med Impact, the company that operates Family Care's online prescription system, to correct the problem. "What should be happening today ... is if a person with a previous prescription comes in for a refill, that should be refilled," Heatherington said. But Melanie Perry, a technician at Christian's Pharmacy, said she wasn't able to refill a prescription Monday, even though Perry worked with Family Care's nurse case manager on Friday. "She was pretty surprised to see that it didn't work," Perry said, when the nurse watched her punch a prescription into the computer. Heatherington said Monday that Med Impact had told him again that everything should be running smoothly this week. There should be no delays for prescriptions for ongoing conditions, such as heart medication, HIV drugs and insulin, he said. Heatherington said when the HMO learned of the problem it told Med Impact on Friday to "grandfather in" _ make refills automatic _ for members with ongoing conditions. But there are some exceptions: If a person comes in for a refill of a narcotic or muscle relaxant, and that person has had another prescription for the same or a different narcotic from another doctor, the HMO would have to give a pre-authorization first. If a person has a prescription refill written more than four months ago, and hasn't refilled it or seen a physician since, he or she would need a pre-authorization, or could use a drug on the new guideline list. If a person has a diagnosis that is not found on the Oregon Health Plan's list of covered conditions, the prescription for that condition would be denied, Heatherington said. Heatherington said Family Care has found cases in which it has paid for prescriptions for conditions not covered by the state health plan. The HMO paid for the prescriptions because it wasn't watching its pharmacy use closely enough, he said. If pharmacists continue to have problems with refills for ongoing conditions, Heatherington said, they should call the nurse case manager at the local Family Care office or at Family Care's toll free number or call Med Impact. Mail Tribune Copyright � The Mail Tribune 1999, Medford, Oregon USA