Refill Authorization; e-prescribing style

Yesterday I was working in the pharmacy and early on in the day I get a call from a patient asking if her refill was ready to pick up.  I looked in the computer and saw that we had not yet heard back from the doctor.  The lady was frustrated because she had been on the phone with the doctor’s office the day before in the afternoon and they assured her that the prescription would be called in to the pharmacy.  The lady waiting for the refill said she would call the office right away and straighten things out.  After ten minutes, she is calling me back saying that the office told her it was sent electronically to her pharmacy.  I said that that is great; however, it wasn’t sent to us.  I ask her if she ever uses any other pharmacies and she said that a couple months ago she had to pick up something late in the evening so she used the big-box store across town near her house.  I said I would call there and see if it had been called in to that store.  After another ten minutes on the phone, I was able to get a transfer of the prescription that had been phoned into the wrong pharmacy.  I called her back and told her what had happened and that it would be ready shortly.  She was very appreciative of our efforts and said she would talk with the doctor’s office next time she was there to make sure that didn’t happen again.

Yesterday, we went through the above process three times at our pharmacy.  Three times we had sent a refill request for different patients to their doctor.  Three times the doctor’s office sent the electronic refill authorization into the wrong pharmacy.  Three times we had lengthy discussion with patients about the prescription authorization not coming through and then going through the process of tracking down which pharmacy it had been sent to.

Before a pharmacist fills a prescription, they need to have authorization from the patient’s physician.  Quite often a physician will write a prescription that has multiple refills; however, after a certain amount of time the refills will become used up or expire.  At that time, the pharmacist needs to contact the physician and effectively get authorization for another amount of time to fill the prescription.  Ideally, this process is in place to assure the patient is receiving the appropriate monitoring for the condition that is being treated with the prescription medications.

When I began practicing pharmacy in 1987, and for years prior to that, when a prescription needed refill authorization, the pharmacy simply picked up the phone and called the doctor’s office to ask for approval.  The staff would usually take the message and then call the pharmacy back within 24 hours with authorization or a note that the patient needed to contact the office for an appointment.

Sometime during the 90’s the process of faxing the doctor’s office came into existence.  This was nice because it was easy to sit at the fax machine with the requests and just send them off.  This process was much quicker than calling each office and leaving a verbal message.  The issue was, faxes got lost.  Regularly the office would tell the pharmacy that they never received the request, or the pharmacy would tell the office that they never received the approval; however, both the pharmacy and the doctor’s office were positive they had faxed the note.  Perhaps the wrong fax number was dialed, or maybe the fax didn’t go through, or maybe they just really didn’t fax the paper, hard to say.  The thought that faxing prescription refill requests and refill authorizations was going to be this super time saver never came true.

Now, here we are in the 2010’s and the game has changed again.  The mode today is that we send an electronic refill request over the internet to the doctor’s computer, provided the doctor is set up with the service to receive these electronic requests.  If they do not receive electronic requests, we send them an electronic fax, from our computer to their fax machine.  If that doesn’t go through, we print off the request and fax it from our fax machine to their fax machine.  If for some reason that doesn’t work, or if they are one of the few offices that still do not have a fax machine, then we print off the request and call them on the phone and request a refill authorization.

All of this happens in reverse when we are receiving authorization to fill a prescription.  First, it may land in our computer directly from the other office.  Next, we may receive a fax from the doctor’s office, or we may also receive a phone call from the office. 

Many different paths a prescription refill request may travel on its way to becoming authorized and filled at your pharmacy.  I ask this of you, please take a moment next time you are at your doctor’s office and make sure they have your current pharmacy documented in their computer system.  This process will help keep your prescription from being called into the wrong pharmacy.


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