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Your pharmacist and what goes on behind the counter

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Posted: Monday, November 11, 2013 12:00 am

FAIRBANKS  — American Pharmacist Month is celebrated each year during the month of October, and because of this, now seems like the perfect time to recognize and celebrate the pharmacist and to talk about what a pharmacy does for you.

Have you ever wondered why it takes so long to get a prescription filled, or why there is sometimes a delay in picking up your prescription? Understanding what happens behind the pharmacy counter can help minimize any frustration you might feel.

The process of filling a prescription includes gathering the information from the patient, entering the data in the pharmacy computer, reviewing the patient’s drug profile, billing the prescription to the insurance company, counting the pills, labeling the bottle and counseling the patient.

Pharmacies utilize technicians to assist the pharmacist in the prescription-filling process. Pharmacy techs are licensed with the state and must work with a pharmacist. The main purpose of the technician is to aid the Pharmacist in the preparation of the medication by gathering your information, billing your insurance and problem-solving any billing issues.

Pharmacists are integral members of a health care team. A prescription order originates from a licensed provider and the pharmacist ensures that the medication ordered is appropriate to achieve the optimal patient outcome without causing any harm. Pharmacists screen for drug allergies, appropriate drug dose, drug interactions and side effects.

Screening for drug interactions is a complicated part of reviewing the patient’s profile, especially if the patient utilizes multiple providers and multiple pharmacies. A pharmacist may ask you if you are taking any other medications, such as over the counter medications (OTCs) or natural products, like Ginseng or St. John’s Wort.

If a potential drug interaction occurs, then a pharmacist must call the physician and discuss whether the drug interaction is significant enough to warrant a change in the medications ordered. It is a good idea for you to use only one pharmacy so that it is easier for a pharmacist to review all the medications you are taking.

Pharmacist counseling is crucial to you and your understanding of the medications prescribed. During medication counseling, you will learn why you are taking this drug, what the drug is used for, how best to take the medication, how to store the medication and what are the potential side effects of the medication.

Knowledge is power and a pharmacist tries to give all the important information about a medication so that you can take an active role in your own care.

The billing process for prescriptions can seem like a mystery. Prescription insurance companies use different rules and terminology than medical insurance companies do.

Typically a pharmacy transmits a prescription on-line to the insurance company in real time. The claim will either transmit back to the pharmacy as a paid or rejected claim. A paid claim tells the pharmacy how much the pharmacy will be paid by the insurance company and how much you will have to pay as a co-pay.

Each insurance company is different and each company charges different co-pays dependent on if the drug is brand name or generic and whether the drug is on the insurance’s formulary. Formulary is a term used to describe an approved list of drugs that the insurance will pay for. Each insurance company has its own formulary.

Medications that are formulary will be more affordable than non-formulary drugs. You may need to pay higher co-pays or pay full cash price when non-formulary drugs are dispensed. Along with formulary requirements, insurances can also impose quantity limits, step therapies and prior authorization requirements for medications.

When a prescription comes back with a step therapy reject or prior authorization request (“PA”), the pharmacist must contact the prescriber. In order for you to obtain the prescription, the prescriber will have to contact your prescription insurance company and give the required information for a prior authorization. These prior authorizations can only be submitted through the provider’s office and may take up to two or three business days to complete.

In some cases where there are formulary alternatives, the provider may change the prescription to the preferred drug on the insurance’s formulary.

Pharmacists are the most accessible healthcare team member, and as such, we are often called upon to answer a wide variety of questions. Not only are pharmacists the medication expert, but we also advise patients about diseases, life style modifications and how to get the most affordable drug. 

Throughout the prescription filling process, the Pharmacist is your personal advocate. We are here to ensure that you are getting the right drug with the right dose and that you understand your medication to the fullest.

Karen Miller, RPh, is the manager of Denali Pharmacy at Fairbanks Memorial Hospital. This column is part of a partnership with Fairbanks Memorial Hospital.

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