The general public assumes that pharmacists merely count and bottle medication, and they give little thought to exactly how their neighborhood pharmacy ‘keeps the lights on’. This same majority of people vaguely assume that their pharmacy, often the most accessible point of entry to healthcare, is fairly compensated by the insurance companies, kept aloft by co-pays or buoyed by front-end sales (are you laughing or crying?). But we know better.
Your patients have little understanding of the generic (or brand) drug reimbursement process or how much it needs to change in order for their community pharmacy to keep the lights on…and the doors open.
The profit margins on generic drugs are shrinking because of the low reimbursement rates set by both private and public third party payers. It doesn’t cost a pharmacy any less in overhead expenses to dispense generic drugs as brand drugs and to counsel the patients using them, so why doesn’t the generic reimbursement structure reflect this fact?
Without change coming from the patient level, your pharmacy can’t hope for it either. One step in the right direction is to help your patients understand the ‘behind the scenes’ process of dispensing a prescription—an often misunderstood and underappreciated course of action. So, the next time they ask ‘why?’ or ‘how come?’ you can tell them.
1. Gather patient information
The first thing pharmacists do after a patient hands them a script is to ask if he or she has used the pharmacy before. If not, the patient or the patient’s advocate will be asked to fill out a patient information sheet. The minimum information required includes: name, address, phone number, email, date of birth, gender, known allergies, current prescriptions, physician’s name and insurance information. Once the patient has completed the profile, the pharmacist then enters the information into the pharmacy computer system.
2. Confirm the physician
The prescribing physician is confirmed at this point. If the physician is not listed in the pharmacy’s software database, the physician’s credentials must be verified. If the patient has elected to use health insurance to cover the cost of a prescription, then the steps are completed with the provided insurance information. Once the information has been gathered, the pharmacist will ask the patient if he or she would like to wait for the medication and will inform them of the waiting time accordingly.
3. Check the script
The pharmacist or tech will then verify the script to ensure that it contains accurate information. This includes correct drug information (name, dosage, and quantity), refill information, and patient and doctor information. If the drug name or dosage is incorrect, if it appears to be unreasonable or if it will counteract with allergies or other medication the patient is taking, the pharmacist will contact the physician to consult on a more suitable prescription, which can involve a lot of call transferring and on-hold time.
4. Assemble the medication
Next, the pharmacist enters the prescription into the pharmacy system. If the medication isn’t in stock, the pharmacist will check with the pharmacy’s wholesaler for availability and inform the patient of the drug’s status. If the patient doesn’t want to wait or wishes to go elsewhere, the pharmacist may suggest a consultation with the physician and arrange for a different drug or dosage for the patient. If the drug is available, the medication and stock bottle are pulled from the shelves, the tablets are counted, and the bag and instructions are prepared for assembly. This, of course, excludes the possibility that compounding is required or a patient has a special request or need.
5. Verify the claim
While the previous process occurs, the claims processing verification is going though the system. This process will occur every time a prescription is brought into the pharmacy to ensure the patient’s eligibility, to check the prescription against the insurance plan’s drug formulary and to establish the co-pay, if one is required.
6. Final steps
Once the prescription is filled, the pharmacist (and only the pharmacist) will verify that each piece of information (dosage, drug interactions, allergies, and quantity, among others) that has been processed is accurate and that the correct medication will be given to the patient. If the pharmacist is filling several prescriptions for one patient, this methodical procedure can be time-consuming.
Lastly, the patient is contacted to pick up the medication. The patient receives his or her medication. The medication is rung up on the cash register (if the patient has a co-pay or is paying out-of-pocket) and the pharmacist asks if the patient has any questions. All pharmacies require that the patient sign a HIPAA and an OBRA policy form outlining the offer to counsel and guaranteeing the privacy of the pharmacist/patient relationship. And the next patient steps up to the counter.
