Who's In Charge Here?


So, the other day in the pharmacy, a patient called me on the phone to ask if her refill was ready to pick up.  She had called in the day before and used our automated refill line to request a refill of her cholesterol medication.  An electronic request had been sent automatically to her prescriber because there were no refills remaining on the prescription.  When I looked at the prescription in the computer I informed her that no, the doctor’s office had not yet called back and her prescription was not yet ready.

After a few moments of back and forth conversation, we identified that this particular medication had been prescribed to her when she was discharged from the hospital last month.  The prescriber was the “hospitalist of the day” and only practices in the hospital.  I looked at her chart and found who her primary physician is and let her know I would send the request off to this doctor. 

She then let me know that because of her insurance she had to recently change HMO’s and now she is with a different medical group.  She has the name of her new primary care physician; however, she has yet to be seen by her new doctor. 

This information changes the game.  I explain that I will print out a request for the refill of the medication.  I will then write a note to the new physician, explaining the situation, and fax the request to the new doctor.  I also discuss with the patient that it would be a great idea for her to call her new doctor’s office and leave a message with the medical assistant explaining the situation.

I have noticed from the patients profile that it has been 32 days since we have filled the prescription.  Before we end the conversation, I ask her if she has any of her medication left.  She says that she took her last dose two days ago and didn’t take any yesterday.  Because this is a maintenance medication and I don’t want her to go without, I ask that she stop by the pharmacy with her empty bottle and I will give her 72 hours’ worth of the medication, to hold her over until the doctor gets back with us.

In this situation, if the doctor does not get back with us within 2 days I will be on the phone calling the office to see what is going on.  We in the pharmacy certainly may not refill the prescription without the physician’s approval; however, it is perfectly reasonable for a pharmacist to provide the patient with three days of maintenance medication while we are waiting, assuming it all appears clinically appropriate and we document all that we have done.

When you call your pharmacy for a refill, please press the button to speak to someone in the pharmacy, rather than using the automated system, if you have recently changed doctors.  Time will be saved if the pharmacy can send a refill request to the correct doctor on the first try. 

This, my friends, is an example of what can be done in a community pharmacy.  Like I have said many times, take the time to develop a relationship with a community pharmacist so that you have someone to go to when you have questions about your medications.  Regularly we get patients who come in who have not yet received their medication from their mail-order pharmacy and they are out of their medication.  We will gladly work with them and do what we can; however, if we have not been filling their prescriptions on a regular schedule, we cannot forward them some until we hear back from the doctor.

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Thanks
Steve
www.AudibleRx.com

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