What You Didn't Know About The World Behind The Pharmacy Counter

Common Issues That May Arise at the Pharmacy and Their Explanations

My little baby Luke coming to visit me at work :)

Before entering the world of pharmacy in 2013, I really had no idea how a retail pharmacy actually worked. Like many people, I thought it was as straightforward as receiving a prescription, pulling the drug off the shelf, putting it in a bottle, and giving the medication to the customer. I quickly learned that the world of pharmacy is so much more than simply “counting pills.” It’s a fast-paced intricate web of checks and balances with a seemingly endless amount of moving parts. I guess this makes sense when you realize that a pharmacist these days has 8 years or more of higher education under their belt. Pharmacists have become an integral part of the health care system and the role is continually changing as we are given more responsibility and opportunity to make a real impact on patients’ health.

However, I feel the role is changing so rapidly that many people don’t realize everything their pharmacist does or what really goes on behind the pharmacy counter. Here is my list of the reasons your prescription might be taking longer than you like (in no particular order):

1) Prior Authorizations

So you got a prescription from your doctor and bring it to the pharmacy. That’s for sure all you need in order for your insurance to pay for the medication, right? Maybe not. Your insurance may require what’s called a prior authorization (or PA) in order to pay for the medication. Basically, they want your doctor to give more information about why you need this particular medication over other maybe cheaper or safer options. This process can sometimes take up to a week and looks something like this:

I know. It’s a giant circle of a mess, but this is what our healthcare system is, and we just have to play by the rules. Your pharmacist does not decide what medications need a PA and is not withholding your medication from you. You always have the option to pay cash for the prescription, but with drug prices these days, I'm not sure if you want to do that.

Some common reasons why a prescription may require a PA are:

• Brand name medication

• Medication is not routinely used in your age, gender, or disease state

• Dose is uncommon

• Insurance requires other medications be tried first

• Medication is considered high risk (ex: a medication that is known for causing dizziness and falls prescribed to elderly patient already at risk for serious falls)

2) The Pharmacist Needs to Call Your Doctor for Clarification

"Ensuring the right dose of the right drug reaches the right patient at the right time by the right route is the minimum standard by which a pharmacist reviews every medication order for every patient." - American Pharmacists Association

Right dose. Right drug. Right patient. Right time. Right Route. These are the "5 Rights" that directs a pharmacist's focus on patient safety and remains at the core of pharmacy practice. To ensure these basic " 5 Rights" are met, the pharmacist may need to call your doctor to clarify information on a prescription, such as to verify a dose or check on a drug interaction. It is outside a pharmacist's scope of practice to fill in certain missing information on a prescription. For example, if there is no quantity on a prescription, we have to call the doctor and get that information from them. Doctors and their staff are people too and these mistakes can happen. Like us, they are typically really busy, and it may take some time for them to call us back. Perhaps they are with another patient. Perhaps you were their last patient and the office went home for the day to spend time with their families. Please be understanding.

3) Controlled Prescriptions

Any kind of controlled prescription (think opioids, many pain meds, anti-anxiety meds, and ADHD meds) takes extra time to process and fill. There are so many extra steps required by law when filling controlled medications. Many states require that a central database be checked before filling any control prescription, and some companies mandate that the doctor be called to verify the prescription before it can be processed. The law requires pharmacists to perform and document these extra steps, and we can lose our license and more if not done according to law. We our doing our best to walk the fine line between following the law and getting you your medication.

4) Brand Name Medications

Medications can come in either brand or generic (like Zolpidem is the generic for Ambien). The brand name medications are usually very expensive and due to inventory costs, pharmacies typically do not keep these in stock continuously. I do try to keep a particular one in stock if I know one of my patients is on it, but if you have a new prescription for something that is only brand name, the pharmacy may need to order it. Most pharmacies get orders many times a week (for non-controlled medications) so it shouldn’t take long.

5) Immunizations

I think it’s great and super convenient that pharmacists can provide immunizations these days. Several studies have shown that pharmacist involvement in vaccines has helped to increase immunization rates which is soooooo important. No appointment is needed, and most of the time, one can walk into a pharmacy and receive the vaccine in 20 minutes or less. However, I have had people come in when I am working by myself and be upset when I tell them the wait may be 30 minutes. Unfortunately, there is no extra pharmacist there to give vaccinations all day. The pharmacist who is filling medication for the 3 people waiting in front of you is the same pharmacist that will give you the vaccine. We also cannot just grab the vaccine out the fridge and stick you with it across the counter. It has to be processed just like every other prescription and prepared for administration. Sometimes 30 minutes is just the absolute fastest we can go.

6) Refill Authorizations

It is so important to pay attention to the number of refills you have left on your medication AND when the prescription expires. That 1 refill you may have left is no longer good if the prescription is expired. Both the amount of refills and the expiration date are usually printed on the bottom of the prescription label on the bottle. I would be more than happy to contact your doctor for a refill, but it can sometimes take a day or two for them to get back to us. To avoid going without your medication, contact your pharmacy or ask your doctor for a new prescription about a week ahead of time.

7) Updated Insurance Information

Make sure to update your pharmacy with any changes to your insurance information. This will help prevent processing delays and get your medication to you as soon as possible. Be on the lookout around the first of the year when many changes occur and new cards are sent. Many insurance companies may also send you a different card for medical insurance (like doctor visit coverage) and prescription insurance for the pharmacy. We cannot use the medical insurance card to process a prescription.

8) Understaffing

This is a big problem in the retail pharmacy world. I am a member of a “pharmacist moms” Facebook group with over 25,000 members, and there is a post (or several posts) every day about how understaffed the pharmacy is. How these companies are continually cutting pharmacy technician hours and doing away with pharmacist overlap, while reducing our pay and requiring us to do more and more with less and less help. There are days where I am so busy that I won’t get to use the restroom or eat at all in my 12-hour shift, and people will still get angry with me when I take longer than a few minutes to fill a prescription. What they didn’t see were the hundreds of prescriptions that were sent in ahead of them on the computer all waiting to be processed and filled, the cars in the drive-through, the line of people waiting to drop off prescriptions, and even more in the pick-up line, the 3 people waiting on hold on the phone, and the nurse waiting to call in a prescription. Who’s filling prescriptions when the pharmacist is stuck on the phone for 30 minutes with your insurance company and the one technician is going back and forth between the line inside and the drive-thru? Please remember that pharmacists and technicians are people too and we are doing the best we can with what we have. Maybe the best thing that a patient can do is call corporate for us and ask them to provide us with more help? They don’t listen to us, but maybe they would to you!

I have personally experienced how frustrating it can be trying to get a prescription filled. It once took a month for me to get my medication, and that’s with me knowing the ins and outs of pharmacy and how the system works. Thankfully, it wasn’t anything urgent or lifesaving, but I know for some, it definitely is. I know it’s hard when you may be sick and tired and frustrated, but a little patience and kindness can go a long way. With just a little respect, I promise I will bend over backwards and do everything I can to help you. That’s why I wanted to become a pharmacist in the first place, to help people. On that note, I love helping people with their pharmacy/prescription/medication concerns! Feel free to contact me with any questions or comments!

#PharmacistsArePeopleToo

Sincerely,

Ray