Question

A patient is written a prescription for Meloxicam, but it is entered in the computer system for Mobic, causing you to receive a TPR from Medicare Part D plan. What could be the reason code for this?

1) DUR required
2) DAW
3) Drug not covered
4) refill too soon

Answer 1

The TPR for Meloxicam entered as Mobic is likely due to a 'Drug not covered' reason, as Medicare Part D might only cover the generic and not the brand name.

Step-by-step explanation:

If a patient is written a prescription for Meloxicam but it is entered into the computer system as Mobic, that can trigger a Third Party Rejection (TPR) from a Medicare Part D plan. In this particular scenario, the most likely reason for a TPR would be a 'Drug not covered' rejection. Mobic is the brand name for Meloxicam, and sometimes insurance companies only cover the generic form due to cost-effectiveness. If the system mistakenly recognizes the brand name drug as not covered when the generic drug is, this would prompt a TPR message from Medicare Part D plan. The pharmacist would then have to ensure that the prescription aligns with what is covered under the patient's Medicare Part D plan.