Problems In The Pharmacy

1
Problems In The Pharmacy

• Dimitry Gotlinsky
• Western University
• Managed Care Clerkship
• ProPharma Pharmaceutical Consultants, Inc.
• 06/23/06

2
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

3
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, theyre only
  pills?
• Why shouldnt I get this cheaper from Canada?

4
Common Causes of Dispensing Errors

• Heavy work load
• Distractions
• Work Area
• Use of outdated and incorrect references

5
Additional Problems

• Staff training inadequate
• Medicines stolen or lost
• Medication given at the wrong time
• Wrong dose of right drug administered

6
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

7
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

8
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)

9
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

10
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

11
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

12
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 lt6 months
  expiration date

13
Ordering Drugs

• Two main sources
• AmerisourceBergen Warehouse
• AmerisourceBergen is more expensive
• Inventory over budget occurs when employees order
  from AmerisourceBergen

14
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

15
Called in Prescriptions BY MD

• Dont have full info about the patient
• Wrong spelling of the name
• Fake prescriptions
• High volume of called in prescriptions
• Dont leave DEA or state license
• MDs are difficult to get a hold of for questions

16
Solutions for Called in Prescriptions

• Always get the patients DOB, phone , and verify
  the address
• Call back MDs office to verify a prescription
• Have MD sign up for electronic prescribing
• Write the time of the call, and fill within an
  hour

17
Conclusion

• Many patients dont 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