Pharmacists receive information necessary to fill prescription medications by means of the telephone, fax, or through electronic transmissions. It is essential to learn when the patient would like to receive the prescription from the pharmacy in order to ensure that medications are processed in the appropriate order to maximize workflow and customer service (American Society, n.d.). The patient must be provided with a cost effective opportunity to substitute generic for name brands when appropriate. The Food and Drug Administration (FDA) provides a comprehensive list of approved generic medications that may be used to replace name brands; however, regulations are not standardized across the states. Therefore, it is critical to adhere to the list specific to the relevant state. It is important to note that there are instances in which the prescriber does not allow or make available a generic alternative. Processing steps do vary as a product of the software utilized by various pharmacies. After a computer order entry has been scanned into the system, the hard copy is routinely and readily available for access as prescriptions are filled and refilled (American Society, n.d.).
Clarifications
Clarifications are required when third party rejections prevent pharmacists from filling prescriptions (American Society, n.d.). Instances in which claims are rejected present time-consuming clarifications; however, this process is critical to customer service. Rejections typically occur when the patient’s identification number is missing or cannot be validated. Rejections may also occur when patients attempt to refill prescriptions before the allowable date. Moreover, when the limits of the prescription plan have been exceeded, a rejection will be generated. When a requirement for prior authorization has not been met, the fill or refill will also be denied (American Society, n.d.).
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Prescription Inclusions and Omissions
Stickers adhered to the face of prescription bottles include information to include the patient’s name and address; name of the medication; manufacturer name and details regarding generic substitutions for name brands; date; dosage, directions to detail dosage frequency and length of term to take the medication; prescription number; quantity in the bottle by count or volume; quantity and date for refills; expiration date; lot number; name of doctor; number of refills allowed; name, address, and phone number of the pharmacy; physical description of the medication; list of side effects; instructions to consult the doctor or pharmacist if breastfeeding; and a skew number (American Society, n.d.). Omissions are typically comprised of a failure to withdraw specific drugs, dosage changes, and inaccurate history of treatments (Velo & Minuz, 2009). When patients transfer between physicians or hospitals, such omissions become increasingly likely.
Medication Errors
Prescriptions should be double checked for accuracy after they have been filled. The National Drug Code (NDC) serves as a rubric for this process (American Society, n.d.). “All procedures related to prescribing are error-generating steps. A prescribing fault can arise from the choice of the wrong drug, the wrong dose, the wrong route of administration, and the wrong frequency or duration of treatment” (Velo & Minuz, 2009, p. 625). The most prevalent errors are characterized by inaccurate dosages, thereby comprising over 50 percent of medication errors. Factors that contribute to these errors include illegible handwriting, incomplete writing or abbreviations, or omissions. The salient fact is, medication errors increase correspondingly with the quantity of steps in the prescribing procedure.
Prior Authorization Process and Medications
Providers must receive prior authorization before they may prescribe specific drugs as a condition of coverage by means of the patient’s prescription plan. “Prior authorization procedures and requirements for coverage are based on clinical need and therapeutic rationale” (Academy of Managed Care, 2012, p.1). The authorization process can take variables such as patients’ diagnoses, height and weight, and results from laboratory tests as part of the adjudication system when determining whether to authorize a medication. Medications that are often misused or abused can be subject to prior authorization. Medications that commonly require preauthorization include Crestor, Humira, Advair Diskus, Destroamphetamine-Amphetamine, Tretinoin, Nuvaring, Celebrex, Adapalene, Suboxone, Absorica, Abilify, and Copaxone. Prescriptions may require prior authorization based on the age of the patient, cost, length of duration that exceeds normal limits, name brand, or if it one of the numerous medications listed by the DoD Pharmacy and Therapeutics Committee.
- Academy of Managed Care Pharmacy. (2012). Retrieved from
http://www.amcp.org/prior_authorization/ - American Society of Health-Systems Pharmacists. (n.d.). Introduction to Pharmacy Practice.
- Velo, G. P., & Minuz, P. (2009). Medication errors: prescribing faults and prescription errors.
British Journal of Clinical Pharmacology 67(6), 624-628.
