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I Have a New Prescription: What Do I Need to Know?

by Roni Shye on March 19, 2014 at 2:28 pm

These days, doctor’s offices have several ways to get your prescription from their office to your preferred pharmacy. Prescriptions can be called in over the phone by authorized personnel at your doctor’s office, handwritten and given to you by your doctor to bring to the pharmacy, sent via fax, or submitted electronically via computer. With so many ways for prescriptions to be sent to the pharmacy, it’s no wonder that when you stop in to your pharmacy, sometimes your prescription may not be ready.

Here are 3 ways to help out your pharmacy and decrease the amount of time to get your new prescription ready:

1.  Make sure all of your contact information is up-to-date

This is very important, and I can tell you 8 out of 10 times most patients’ information is NOT correct or up-to-date. By making sure that all of your information (name, date of birth, phone number, and address) is clear, concise, and current, you allow the pharmacy to ensure that they are filling your prescription for the correct patient, and that if there are any issues with your prescription they will be able to get in touch with you.

2.  Make sure all of your insurance information is up-to-date

Making sure that your insurance information is up-to-date is a very important step for the pharmacy when it comes to filling your prescription. If your insurance has expired, your pharmacy may do either of the following:

Put your prescription on file and not fill it.  If your prescription is ‘put on file’ that means that the medication was not counted out or essentially “filled” for you yet. Once you present your new insurance information, the pharmacy will have to process and fill the medication. This seems simple; however, it may take some time depending on how busy the pharmacy is, and there could be a delay in getting your new prescription.

Process your prescription and fill for the cash (or uninsured price). If your prescription was processed and filled for the cash (or uninsured price), that means that it should be ready for you at the pharmacy. Once you present your new insurance card, the pharmacy will be able to re-bill it and have you on your way as long as there are no billing issues with your insurance.

Some billing issues that the pharmacy could run into with your insurance may include:

  • Prior authorization required (you will need permission from your insurance company to fill your prescription)
  • Max day supply (you can only fill a 30 or 90 day supply at one time)
  • Non-formulary medication (your prescription isn’t on your insurance’s formulary, or list of covered drugs)

Unfortunately, both processes can pose problems and may lead to increased wait times for your prescription—that’s why it’s important to always make sure your insurance information on file is correct and up-to-date.

If you don’t have insurance or if you run into a billing issue, this is where you may want to look for a discounted cash price. Issues like prior authorization and max day supplies are limitations put in place by your insurance company, and if you pay cash or use a discount, you don’t need to worry about them.

3.  Call the pharmacy before coming in to pick up your prescription

Calling the pharmacy before physically going there can be very helpful and could even save you an unnecessary trip. In case your pharmacy hasn’t been able to reach you about any of these issues, calling ahead will let you know before you go in whether:

  • Your medication is not in stock and will need to be ordered in for next day pick up. Due to the popularity of some medications, it can be hard for pharmacies to keep enough in stock depending on how many prescriptions are filled in a day for the same medication. However, most pharmacies—depending on the type of medication—are able to order your medication in for next day pick-up.
  • Your medication is not fully in stock and a partial fill can be given until the medication is ordered in. If your medication isn’t in stock, it’s also possible that the pharmacy may be able to supply you with a 1 to 3 days of your medication while they order the remaining quantity in. Unfortunately, you will need to make a second trip back to the pharmacy; on the other hand, you will not go without your medication.
  • Your medication requires a prior authorization from your insurance company. A prior authorization from the insurance company basically means that your insurance company requires more clinical information from your doctor’s office as to why you need to be on this particular medication. The process can often take between 1 – 7 days depending on how fast your doctor’s office fills out the required paperwork.
    • Prior authorizations are usually required for expensive medications which often have less expensive alternatives. The insurance company wants to make sure that you have tried these less expensive alternatives or that the doctor feels you could benefit from the more expensive medication.
    • This is one way insurance companies try to save money; however, each prior authorization case is unique and may be approved or denied.
  • Your medication is not covered by your insurance. Each insurance company has a formulary which may or may not include the medication your doctor has prescribed for you. A formulary is a list of medications your insurance company will cover—to an extent—and the remaining cost is considered the responsibility of the patient, also known as the co-pay. If your prescription isn’t covered by your insurance plan, you do have some choices:
    • Pay for the medication out-of-pocket or with a discount card. This may or may not offer a significant cost savings depending on the price of the medication.
    • The pharmacy can call your doctor and suggest alternatives that would be covered be on your plan’s formulary.
  • Your prescription requires further clarification from your doctor. Doctors are human and, they can sometimes make errors. However, pharmacists are part the “check and balance system” to help prevent errors from making it to you. The following are some examples as to why the pharmacy would require further clarification on your new prescription.
    • Unreadable handwriting
    • Directions, quantity, or refills are missing or incorrect
    • Incorrect dosing
    • Interaction with another medication you’re taking
    • Prescription written for the wrong patient
    • Your doctor’s input is needed when your insurance requires prior authorization or doesn’t cover your prescription

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