Therapeutics

When the pharmacy calls

The first in this two-part series discusses the challenges practices face when the pharmacist requests changes to the patient’s prescription.

BY JIM THOMAS, EDITORIAL DIRECTOR

The scenario is not uncommon: A patient leaves the ophthalmology practice with a prescription in hand or the practice sends an e-prescription to the pharmacy. Once at the pharmacy, however, the patient might not receive the medication as prescribed. This situation, often frustrating for the physician and the staff, as well as the patient, can occur for any number of reasons. (See “Changing prescriptions” on page 15.)

Regardless of the reason for the change, the next step usually is for the pharmacy and/or the patient to call the practice to request approval for the change. For some who responded to a recent Ophthalmic Professional e-mail questionnaire, these calls to request medication changes can pose concerns for the practice, some of them serious.

The question of patient care

“Patients can miss several days of medication or have to reschedule surgery due to the process of reviewing and communicating with the pharmacy, affecting the quality of care,” says Laurie K. Brown, MBA, COMT, COE, administrator at Drs. Fine, Hoffman & Sims in Eugene, OR.

In addition, “There are times when there is a reason that a physician will prescribe a brand name medication,” says Janet L. Hunter, COMT, BS, president of Eye Source, LLC, an ophthalmic training company. “When the pharmacist changes to the generic without first checking to make sure it is OK…it could be interfering with the patient healing process.”

For example, at Shepherd Eye Center, the physician will “only prescribe brand names when the patient has had trouble in the past with allergic reactions or the generic not controlling the issues,” says Christina Kennelley, administrator for the practice located in Las Vegas, NV.

Also, when a change is requested, practices may face the challenge of “finding an appropriate substitute,” says Ms. Kennelley.

Calls from the pharmacist require the practice to review the request. “We question if the change was made by the pharmacist or approved by the doctor and why,” says Keshia Beckford, COA, clinical operations manager at Ophthalmic Consultants of Long Island (OCLI) in New York. “Most times, the doctor does not have a preference, as both the branded and generic drugs are the same formula, but the patient requested the brand because they are more familiar with the name.”

Ms. Beckford notes that OCLI doesn’t face “many issues at all” when the practice receives a call from the pharmacy to request prescription changes because “the front desk staff is knowledgeable about the generics and which brand they correlate with.”

The management issue

When the effectiveness of the generic formula is not a problem, practices can face other issues. Some report instances in which neither the pharmacy nor the patient calls to confirm the switch with the practice. And when practices receive calls, often from both the patient and the pharmacy, it becomes a question of efficiency.

Even a handful of calls can add up to a significant amount of time for staff, especially for those practices that keep a sharp eye on workflow and efficiency.

“It takes time to receive the call, research it, then call the pharmacy to either OK or not OK the requested change, and then the practice must call the patient to explain the change or the reason not to change,” says Ms. Brown.

Ms. Hunter agrees. “Pharmacy calls are very time consuming,” she says. “These calls are usually taken by the technical staff, thus contributing to decreased patient workflow because a staff member is not able to continue seeing patients due to answering phone calls.”

The preauthorization challenge

The pharmacy may also call to notify the practice that the prescribed therapy requires preauthorization by the insurance carrier — that is, the practice must get approval for the prescription by the insurance carrier before the carrier will cover the prescription.

“We did not have a person for this in years past, and now our surgical preauthorization person is doing a fair amount of medication preauthorization,” explains Ms. Brown. “It is a very inefficient process and should be dealt with by the pharmacy, not the medical practice.”

According to Ms. Brown, a staff member must take several steps to complete the process, which include:

• determining what the patient’s prescription insurance (not medical insurance) covers. “This requires a lot of digging and calls to the pharmacy and patient.”

• tracking down the correct preauthorization form to use, by either calling the insurer or locating the form on the company’s website.

• completing the form and submitting it to the insurer.

• following up to verify that the insurer receives the form and approves the preauthorization.

• confirming the pharmacy did receive approval.

The technician must take additional steps if the pharmacy does not receive preauthorization approval from the insurance company. “This is a very real headache that drives up the cost of care for physician practices,” says Ms. Brown. OP

In our January/February issue of OP, ophthalmic professionals will discuss how they manage pharmacy calls and preauthorization requests to minimize inefficiencies and maintain an efficient workflow.

Ophthalmic Professional invites readers to submit tips for managing pharmacy/patient requests to change medications, which we may publish in the article. E-mail your tips to james.thomas@pentavisionmedia.com.