Therapy

When the pharmacy calls

The second of this two-part series discusses how to better manage pharmacy call backs.

BY JIM THOMAS, EDITORIAL DIRECTOR

Upon leaving their preferred pharmacy, patients expect to receive the medication as prescribed by the physician. However, several factors might complicate an otherwise smooth transaction. For example, the insurance carrier might not cover a branded medication but will cover a generic version. The pharmacy might offer the patient a generic version or might not have the medication in stock. The insurance carrier might require prior authorization to approve coverage of the prescribed medication. (See Ophthalmic Professional, November/December 2015, p. 14, for a discussion of these issues.)

Regardless of the reason, callbacks from the pharmacy cause delays for the patient, the pharmacy, and the practice.

“It takes time to receive the call, research it, then call the pharmacy back to either OK or not OK the requested change,” says Laurie K. Brown, MBA, COMT, COE, administrator at Drs. Fine, Hoffman & Sims, LLC in Eugene, Ore.

However, as leading ophthalmic professionals interviewed for this article note, practices can take several steps to help minimize the impact of callbacks.

Patient education

The first step in minimizing callbacks is to educate patients before they leave the practice. Explain why a particular drug was chosen and whether a generic drug is appropriate. The staff members at Shepherd Eye Center in Las Vegas also include information on drug cost.

“We try to let the patient know the cost of the medication prior to leaving the office,” says Christina Kennelley, administrator. Through Shepherd Eye Center’s electronic medical record (EMR) system, staff members can view the insurance co-pay and notify the patient of the cost.

One of the most effective actions to reduce the number of callbacks is to “discuss the generic alternative at the initial prescribing of the medication,” says Janet L. Hunter, COMT, BS, president of Eye Source, LLC.

At Ophthalmic Consultants of Long Island in New York, if the doctor does not have a preference for the branded vs. the generic drug, the practice lets the patient know that a less expensive generic is available. “If the patient prefers the brand, we advise it may be more expensive. If the patient insists on the brand, we note DAW (dispense as written) on the prescription,” says Keshia Beckford, COA, clinical operations manager. The staff is trained to check that DAW is noted before sending the prescription to the pharmacy.

Electronic solutions

EMR/e-prescribing systems, such as the system used at Drs. Fine, Hoffman & Sims, LLC, include a spot to click within the patient record that notates “brand only” or “generic OK,” says Ms. Brown.

EMR and e-prescribing tend to reduce the number of phone calls from the pharmacy “because the question of generic or brand are answered at the time of the prescription writing,” says Janet Hunter. Just this one step, the physician noting on the prescription whether a generic medication is acceptable or brand name is required, “would save a lot of time and extra phone calls,” she says.

Managing the call

The above steps can help minimize callbacks, but chances are, they won’t eliminate them. To maintain efficiency, practices should consider streamlining internal processes. For example, Shepherd Eye Center uses a designated medication line. A technician or scribe checks the line’s voicemail “every couple of hours,” says Beth Hunter, COT, clinical manager. For refill requests, the technician checks the chart to see if refills are available, calls the pharmacy on file to make sure it has refills, and then notifies the patient.

“We try to triage the calls so only the ones that need the doctors’ input are sent to them,” says Beth Hunter. If the request requires immediate attention, the caller can press “0.” The operator will then find a technician to triage the call.

If the call is for a medication change or a request for a generic medication, the call is noted in the patient chart and sent to the physician’s task basket. Physicians and their scribes check their baskets at the end of the morning and at the end of the day.

Ophthalmic Consultants of Long Island trains front desk staff members so they are knowledgeable about the generic versions of branded drugs, says Ms. Beckford.

At the practice, “Incoming calls are handled and triaged by the patient care coordinator,” says Ms. Beckford. The coordinator takes a message and submits it to the doctor’s technician or scribe, both of whom are trained in pharmacology. The technician or scribe confirms the change with the doctor and either sends the new prescription electronically or phones the pharmacy to answer the request.

The physicians at Valley Eye Professionals in Huntingdon Valley, Pa., provide a medication list that includes the names of the medications, common usage and medications that require physician approval for renewal. The list allows phone employees to answer many pharmacy calls. Phone employees become familiar with the patient history section of the practice’s e-prescribe where they can see if a medication was prescribed. “This helps with patients’ prescription inquiries,” says Eleanor Groome, COA.

When Drs. Fine, Hoffman & Sims receives medication substitution calls, the practice receptionists make a phone note and route it to the technician desk. Usually at the end of the morning or afternoon, when through with the patient schedule, a technician then checks the patient’s chart to see if the generic is OK. If there is a clear answer that follows protocol and does not require physician authorization, the technician calls back with the appropriate answer. A notation is included in the patient’s medical record and ultimately signed as approved by the physician.

The practice also has a protocol for staff to reference a listing of prescriptions that can be renewed, for glaucoma or allergies, for example, as long as the patient is in compliance with visit recall. If the patient is overdue for a visit, the practice “may approve one refill after checking with the doctor,” says Ms. Brown. The practice will schedule the overdue appointment while the patient is on the phone.

Drs. Fine, Hoffman & Sims also lets the pharmacy and the patient know when “the physician has selected the particular product due to efficacy,” says Ms. Brown. “We have specific verbiage we use to communicate this to the patient and pharmacy.”

When receiving a medication substitution request, Valley Eye Professionals asks the patient to contact the insurer to learn what medications are covered. This coverage information is forwarded to the doctor who then sends a new prescription to the pharmacy. The practice confirms that the pharmacy will call the patient to inform them of the new prescription.

The issue of preauthorization

As reported in the November/December issue of Ophthalmic Professional, insurers can reject coverage for medications that require prior authorization from the insurance carrier. To gain prior authorization for a specific medication, the practice must identify what medications the patient’s insurance plan covers and then locate and complete the insurer’s preauthorization form and submit it to the insurer. The practice often must follow up with the insurer to check on the prior authorization and, when finally authorized, confirm that the pharmacy received the approval.

While there are no silver bullets to eliminate the burden of prior authorizations, there are ways to minimize the impact.

Shepherd Eye Center limits prior authorizations by using the practice’s EMR to determine patient eligibility for a medication. “This is done right in the exam lane when the physician can discuss with the patient the cost and importance of why the medication is chosen,” says Beth Hunter.

The practice will submit authorization requests for certain medications, “but we try to go with the generic as much as possible,” Beth Hunter says.

Once alerted to a prior authorization, Valley Eye Professionals asks the pharmacy to fax the insurance company’s denial of coverage, which includes the patient’s pharmacy and insurance numbers. The information is entered into a web-based password-protected portal (PARx Prior Authorization Support System, or PASS), which manages the prior authorization process at no cost. (The service is supported by those pharmaceutical manufacturers whose products are available in the PASS system.) Users “find the products available in the PASS system represent a high percentage of their prescriptions that require a PA,” says Dan Rubin, president and CEO of PARx Solutions. According to the PARx website, most requests can be processed within 48 hours.

“It is good to let the patient know the preauthorization process can take a few days,” says Ms. Groome. OP