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Problems In The Pharmacy Dimitry Gotlinsky Western University Managed Care Clerkship ProPharma Pharmaceutical Consultants, Inc. 06/23/06 Working as a Community Pharmacist Fill and dispense prescriptions High script volume Consult on new prescriptions and OTCs Insurance issues Calling doctors for new RXs or new directions Calling for copies or transferring RXs Concerned with sale and supply of medicines Stock control Dealing with upset or angry customers Difficult Pharmacist Questions Why do my medications cost so much? Do I really need to have this filled? Why do I have to wait so long, they’re only pills? Why shouldn’t I get this cheaper from Canada? Common Causes of Dispensing Errors Heavy work load Distractions Work Area Use of outdated and incorrect references Additional Problems Staff training inadequate Medicines stolen or lost Medication given at the wrong time Wrong dose of right drug administered Refills Many patients think: a) have unlimited amount of refills b) can get refills approved right away c) blame the pharmacy for not automatically getting the refill for them Getting refills or new prescriptions on the weekend Large volume of refill request per day Refill to soon Solution for Refill Problems Prefilling prescriptions Giving a prefill without an approval from MD Giving hold over for couple of days In case of emergency or during the weekend, contact MD on call Faxing instead of calling Reminding the patient to call for more refills ahead of time Insurance Problems By far the biggest problem in the pharmacy Missing or lost drug cards Deductibles issues Multiple insurance cards Prior authorizations Multiple tier co-pays Insurance not contracted with the pharmacy Coverage terminated TARs (treatment authorization requests) Solution for Insurance Problems Not too many options Give loaners to patients who are waiting for PA Always have an experience insurance employee on staff List of direct phone #s for pharmacy help desk Mail-Order Problems Rx runs out before mail order arrives Lost in the mail Never sent Rejection from insurance to pick up medication at a community pharmacy Higher co-pays when picking up at a community pharmacy Solutions for Mail-Order Problems Calling insurance to get an approval for a short term supply Higher co-pays can still be a problem Sometimes give out for free a 2-3 day supply In some cases patient just pays out of pocket, and is reimbursed by insurance Inventory Budget Each pharmacy has a different inventory budget Based on the volume of prescriptions Inventory audits happens every quarter If over budget must send prescriptions back to manufacturer 2 weeks out of the year when you can send prescriptions back without a restocking fee Can not send back anything with <6 months expiration date Ordering Drugs Two main sources AmerisourceBergen & Warehouse AmerisourceBergen is more expensive Inventory over budget occurs when employees order from AmerisourceBergen Solutions Not to Go Over Budget Check inventory every week, instead of once a month Proper training from employees on how and where to order from If over budget occurs, return drugs back to manufacturers during non-penalty period Cut hours if volume of drugs drops Called in Prescriptions BY MD Don’t have full info about the patient Wrong spelling of the name Fake prescriptions High volume of called in prescriptions Don’t leave DEA or state license # MDs are difficult to get a hold of for questions Solutions for Called in Prescriptions Always get the patients DOB, phone #, and verify the address Call back MD’s office to verify a prescription Have MD sign up for electronic prescribing Write the time of the call, and fill within an hour Conclusion Many patients don’t really know what a job of a retail pharmacist entails People think that pharmacist only count pills and fill prescriptions Pharmacy has expanded its role within the healthcare delivery system