Behind the Scenes at the Pharmacy

You asked, we answer. Your questions that we have gotten about pharmacy procedures answered below.

I plan to update this post if more great questions come in that I can help with, so keep ‘em coming!

Why does it take so long for the pharmacy to fill my prescription when it’s just slapping a label on a box?

Technically, you’re right. Those don’t take long.

Except that:

There’s always someone in front of you – often multiple people. It’s not fair to do yours first just because it’s easier.

The prescription needs to be typed in (if it’s a new one*), and then reviewed through the interaction and allergy/health condition/age/dose-checking software. It then must be reviewed for typing errors before it can be filled. It also must pass through your insurance to see if everything meets those requirements.

Then a final check that the product selected is the one needed. Special requests for certain manufacturers or other needs also may cause a delay.

Another reason you may have to wait is the size container the doctor ordered may not be in stock and has to be ordered. If they have a different size in stock, they may have to call the doctor to see if it’s ok to dispense that size.

Possibly the drug is out of stock completely, in any size.

In addition, if there’s something missing or illegible or not right about the prescription, they also have to call the doctor to get clarification.

This post contains affiliate links. I may receive commissions for purchases made through links in this post. Full disclosure statement here. You do not pay any extra. Thank you for supporting us.

*By “new one” (aka new prescription), I don’t mean, new-drug-to-you.

---

Let’s take a look at how long a prescription is good for:

Every prescription, by federal law, has a MAXIMUM length of 1 year** from the date written that you can fill it or get it refilled.

Many times the doctor states, “add this to the refills on the prior prescription”) - except they technically can’t do that.

Why? I’m glad you asked!

Because this authorization date (for the extra refills) is now a brand new date, those “refills” are actually a new prescription with refills, good for a year from the new date.

The best the pharmacy can do is put the new prescription on file and keep filling from the old one until the refills run out or it expires.

**Controlled substances are only good for a maximum of 6 months after the date written.

Some states have stricter laws on some controlled substance prescriptions and they are good for even less time than that.

So when your doctor keeps ordering your Ambien, with a year’s worth of refills? The pharmacy is not shorting you your refills. The law doesn’t allow them to fill it after 6 months or 5 refills (or 1 refill if you get a 90-day prescription). Some state laws may be even stricter on quantities and refills.

Why does my Doctor order 100 and I only get 50?

Sometimes they only have 50 in stock, so if you need it right now, they have to short you and make it up later.

Sometimes it’s an insurance issue - that’s all your insurance will pay for.

If it’s a Prior Authorization issue, check out this post for those answers.

Speaking of insurance - did you know there are TONS of different insurance plans out there?

The pharmacy staff members may be familiar with some common plans, but not all.

And they keep changing.

ALL THE TIME - not just at the beginning of the year!

And there are SOOO many variations on a plan.

I've said it before and will repeat here - YOU are the most important person on your own healthcare team. Arm yourself with knowing your prescription insurance benefits so you're not annoyed or surprised and can focus on working on a solution.

It happens to us all - we get caught off guard when something comes through for a HUGE copay that we weren't expecting. Or needing a prior authorization first.

I will take the liberty to say this because I don't work in one of the pharmacies:

Please remember to keep your poise and decorum.

Stay classy - even when poop happens. And you know it will. We have just been discussing the poop this whole post.

Arm yourself with knowing your prescription insurance benefits.

~ Julie A Hernandez

Please do not yell at the pharmacy staff - they're just the messengers, and are often trying to help you.

They are patient-focused and on your side. They didn't make the rules OR make you pick that plan.

Regarding “may substitute” and Generics - To our Physician Friends

Any box or line that says, “may substitute”?

That’s talking about DAW (Dispense as Written) - generic is ok or is not ok to substitute.

It’s NOT talking about, may substitute capsules, liquid, another strength and take half or double and adjust the quantity.

THOSE THINGS ALL NEED A VERBAL OK TO A LICENSED PHARMACIST OR INTERN BY AN AUTHORIZED PERSON AT THE DOCTOR'S OFFICE.

(Best practice: Be proactive and write on the prescription (if it truly is ok with you) - may use any salt form or dosage form or substitute strength if needed - that would save some phone and wait time for everyone.)

Patients - do not write on the face of the prescription. This is not legal for you to do so. Changes must be made by a pharmacist or an authorized representative of the doctor or person who wrote the prescription.

Doctors, PAs, NPs, Veterinarians - please make a note - if you order a cream, but it doesn’t come as a cream, technically the pharmacist has to call and get the ok to change to ointment (or whatever) -unless you have written something specific as mentioned above that it's ok to substitute dosage forms.

If you order NO dosage form or salt but it comes in more than one?

Same thing - the pharmacist must document that they clarified (with someone at the doctor's office) what form or salt was intended. Again, unless you specifically indicate otherwise on the prescription.

Speaking of Generics and DAW

EVERY drug has a generic NAME. Every drug.

It starts off with the formula and generic names when they are developing the drug, and they have to figure out a brand name.

Just because there’s not a GENERIC SUBSTITUTE available on the market doesn’t mean that it doesn’t have a generic NAME.

Why is my medicine so expensive?

Your insurance, if you have prescription benefits, determines the prices with each pharmacy.

But, guess what? This is America. You’re not a hostage. Shop around!

YOU are the most important person on your own healthcare team.

~ Julie A Hernandez

Sign up for more than one discount prescription card, in addition to having your insurance.

Shopping around means you can check the price for your medicine:

• at Walmart (without an insurance card),

• on each of your discount cards at multiple pharmacies, and here’s one you might not know:

• Sam’s Club and Costco (in some states based on state law) pharmacies are open to the PUBLIC - even if you’re not a club member.
  • Call or go on their website to check prices (personal experience has shown me that Costco’s website pricing differs from the actual pharmacy pricing).
  • You will NOT be able to sign up for THEIR discount card if you aren’t a Club member, but at least you can get medicines filled there.

• Don’t assume independent pharmacies will be more expensive, either. They have their own niches and may have the same medicine at a significant discount.
  • Sometimes the big corporate pharmacies’ company policies do not allow them to accept certain discount programs, where the independent pharmacies will.

• Last-ditch effort for expensive brand name items: Do a web search for your medicine and head to the manufacturer’s website. See if they will send you a rebate, offer a discount coupon or card, a coupon for a free month, or anything to help you out with the price.

Medicare STARS Ratings

What's this, you ask?

If you have Medicare, they rate insurance companies by something called STARS - the ranking is 1 (lowest) through 5 (highest).

Why?

Because for some reason the government now has, as part of its STARS criteria for excellence, Patient Adherence to Medicines.

What does that mean, and why should I care?

It means the feds (aka Medicare - CMS - NOT the FBI) want to make sure you're taking your medicine - every single dose - and refilling on time.

Here's why you should care:

I TOTALLY get how it's really easy to forget to take a dose. Sometimes once or twice a week, even.

And the more pills you have to take, or the more the injection hurts or makes you queasy to think about needles, the more doses you probably miss.

I get it. Hey, I'm in the biz, and I even forget. Or I think, I'll take it later - and then bedtime comes and I've forgotten for the day.

I'm not talking to those of you who miss more than a dose or two a week.

If you DO miss more, you may be the reason CMS is trying to make insurance companies get a plan to help patients with their adherence.

In case you hadn't noticed (or if it hasn't happened to you yet), people will be blowing up your phone.

Well, not literally, like with a bomb.

I mean, they will call you a lot. Or text. Or email.

About this very thing.

You'll get requests for surveys about how often you miss a dose, and what tools do you think would help you remember better, and so on.

The Medicare insurance plans are trying to improve their STARS ratings with the feds.

Nobody wants to be ranked low. You wouldn't, either, i'm sure.

Here's what you can do, besides trying to figure out a system for your medicine usage.

Note - this is JUST MY OPINION.

If you get a survey, or if you see an opportunity to rate your insurance plan or the pharmacy benefits manager who services that plan, TAKE THE SURVEY/do the rating or review, ESPECIALLY if you have no complaints.

It's human nature to complain when things go wrong, and forget when things are going ok or well.

As humans, we seem to receive more NEGATIVE feedback than positive.

And who DOESN'T like to get a pat on the back?

I have NO official bug in my ear, and I don't know if this will work.

But if it does, then that COULD save you the hassle of having to answer a bunch of phone calls or emails about why-aren't-you-refilling-your-medicine-on-time and what-are-we-gonna-do-about-it.

Because really. Why should CMS rate the insurance companies on why YOU as a consumer forget to take your medicine once in a while?

Maybe I'm missing something, but that's just weird and possibly intrusive.

My bottom-line idea - give them good ratings (not falsely-good - don't lie) so their STARS ratings go up and maybe they won't need to blow up your phone about missing a couple doses a month.

Just an idea. Not a fact. It's worth a shot.

---

Pharmacy friends - anything else to add? Drop a comment below ~