There are many reasons why things can go wrong at the pharmacy, but getting angry or upset never helps speed things along. In fact, there are some things that pharmacists and pharmacy techs wish patients knew before coming in that could help mitigate a lot of issues that arise at the counter. After consulting with a pharmacy tech who’s worked in the field for over a decade, we’ve pulled together the most important ones.
On Laws
There are many, many laws that pharmacists and pharmacy techs are bound by. There are lines they cannot cross and actions they cannot take, even if they want to. For example, legally, pharmacy techs have to count the medicine they are filling two times, and then wait for a pharmacist to verify it. But what if the pharmacist is wrapped up in a phone call with someone’s doctor, or stuck on the phone with a patient who’s hyperventilating because of an adverse effect? The pharmacy techs can do nothing but wait. It’s the law. When techs give you an estimate of how long it will take to fill your medication, it’s an estimate only. There are many things that can happen that they have no control over.
Another thing pharmacy techs are not allowed to do is rewrite or change your prescription in any way. They have to go by exactly what is written. For example, if your doctor prescribes you 100 pills and no refills, but your insurance only covers 90 pills at a time, then you can only receive 90 pills when you go in, and the remaining 10 pills will be considered your refill. Your refill will not be another 90 pills, since the total you were prescribed was 100.
In addition to the number of pills, if your doctor specifically prescribes capsules, then the pharmacy cannot give you tablets. If the pharmacy only holds the tablet form of that prescription since it’s the most common, then they won’t be able to fill your prescription. However, if your doctor does not specify the form your prescription should take, then techs can work with you to give you the cheapest option (capsule or tablet).
On Refill Timing
Did you know that if your prescription is a non-controlled drug, you can work on getting a refill 80% of the way through the prescription period? For example, if you have a 30-day supply of medicine, you can refill it once you hit the 24-day mark, or six days early. If you take a controlled substance, then you can refill 90% of the way through the prescription period. You could wait until the last minute, but it’s very discouraged, and here’s why.
“A lot of patients come up to us and want to refill something the day it runs out. That can present a whole number of problems,” says Denson. “For example, if you come to me on Friday night and you are out of refills, you are out of quantity, and it’s a controlled substance, there’s no way we can [get you a refill]. Doctors are going home at five o’clock, they’re going to have the whole weekend alone, you know? If you wanna see Urgent Care they might write a prescription for you, they might not. Depends on them and depends on the prescription.”
So if you wait until the last minute, you risk the pharmacy not having your medicine in stock or not being able to reach your doctor to submit a refill request. “Six days of leeway [for most 30-day prescriptions] or three days in the way of controlled [prescriptions] is plenty of time to resolve most issues,” says Denson. He had another suggestion as well. “It doesn’t hurt to ask when you can fill those again. Write it right on your bottle, it’s a paper label. Just keep track of refills. It says no refills remaining? You need a new prescription, end of story.”
On Refill Requests
Pharmacists and pharmacy techs cannot dictate what your doctor will do. If you go into the pharmacy and you are out of refills, and you need a prescription, pharmacy techs can do what’s called a refill request. They’ll send a piece of paper, usually by fax or electronically, to your doctor saying, ‘This person wants to refill this medication.’ After that, it is out of the pharmacy’s hands. The doctor has their agency and will approve or decline medications. “We don’t always know why [they make their decisions],” says Denson. “Sometimes they leave a response, but it’s pretty rare. Oftentimes it’s simply ‘Denied’ and you need to go talk to your doctor.”
On Insurance
One thing that pharmacists and techs hear a lot is, “But my insurance should cover that!” Pharmacy techs have no control over what your insurance does and does not cover, and there are a few nuances and terms here that they recommend all patients understand.
- Just because your doctor prescribes you a certain medication doesn’t mean that it’s “covered” by your insurance. A prescription merely means you have the legal right to pick up that prescription at a pharmacy. You can pick it up at full price all you want, but the doctor nor the pharmacy has any influence over your insurance.
- Just because a medication is “covered” by your insurance doesn’t necessarily mean they will pay for it. For example, if your medicine is covered by your insurance, but you haven’t reached your yearly deductible yet, you will pay for the entire cost of that medication and that amount will go toward paying down your deductible. Once your deductible is reached, then your insurance might pay for some or all of it, depending on your plan.
- Every insurance company has something called a formulary. A formulary is basically a list of medications that they will cover, might cover, or won’t cover. The “might cover” medications typically need something called a prior authorization. “Basically, the prior authorization is when insurance is like, ‘I’m not sure if I want to pay for this. Can you tell me why you’re taking it?’”explains Denson. “It’s paperwork that we send to the doctor, who then fills it out and sends it to the insurance. They basically explain why [the patient] is on this medication.”
A final word on prior authorizations is that they expire. “They usually expire at a year, but we see it as short as six months, three months, maybe less,” says Denson. “So if you come to us to get a refill and, by the way, now it needs a prior authorization again, you have to know that’s a possibility…[which is] another good reason to come in days before you run out instead of the day of, or the day after for that matter.”
A Little Trust Helps
Some patients don’t like sharing their personal information, for one reason or another, but patients need to understand that pharmacists and pharmacy techs have access to all of patients’ health information. They have to have that access in order to double-check that allergies and conditions aren’t affected or exacerbated by new medications. “You gotta trust your pharmacy,” says Denson. “We’re not out to rip you off. We want you to have a zero-dollar copay. We get paid better when you do have a zero-dollar copay. But it’s not our choice. It comes down to a thousand factors that the technicians or the pharmacist don’t have any choice over. Oftentimes when we see you being ripped off, we’re gonna go to bat for you. ‘Hey, you don’t need this combination of drugs that cost three hundred dollars a bottle. You could split it into these two and it’ll be eight dollars.’ We’re going to go to bat for you if we can.”
