Blog by Mark Wolfe, Customer Account Representative, GrandView Pharmacy

Many times, I hear complaints from nurses at senior care facilities’ that the pharmacy did not send the medication to them on time.  There could be many reasons why that might be but understand as a pharmacy provider, it is our job to see that prescription orders are filled.  So, what is the hold up, why don’t some prescriptions get filled in a timely manner?

At GrandView Pharmacy we have identified six barriers that often get in the way of getting the right medication out in a timely basis. These reasons are…

1. Controlled Substances
2. Order Clarification
3. Product Availability
4. Insurance Coverage, Refill Too Soon
5. Insurance Coverage, Non-Covered Item
6. Human Error

Controlled Substances:  To fill a physician’s order for a controlled substance, a written prescription MUST be provided to the pharmacy.  No exceptions.  In Indiana, a physician’s agent can call in an order for Controlled 3, 4, or 5 drugs.  Yet, a C-2 are to be filled with a written order from the prescriber.

Order Clarification:  This occurs when the pharmacy receives an order that is UNCLEAR, missing a physician’s signature, or the order did not indicate dose, quantity, strength, etc.  So, before you send an order through, please check to see if all the information needed is present.  GrandView has redundant internal procedures that require a pharmacist to call the facility to clarify an order, to see that the order is complete.

Product Availability:  Either the pharmacy has not received their supply from their wholesaler, or the there could be a back order. Meaning the product is only “temporarily” out of stock.  If GrandView is out of a medication we will put forth a reasonable effort to borrow or buy a medication from another pharmacy or hospital so that a sufficient supply is obtained.

Insurance Coverage:  As you may well know, not all health care insurance plans are equal.  In this case, an insurance plan may not allow a prescription to be filled at that time as the insurance provider determines a refill is being requested too soon to be filled.  GrandView personnel will call insurance providers to get authorization for the medication, or suggest a therapeutic substitute that is covered under the patient’s insurance plan.

Insurance Coverage, Non-Covered Item:  In this case, a medication is not on the insurance plan’s approved formulary; that is, a medication has not been pre-approved as acceptable for this insurance plan.  GrandView personnel will call the insurance provider to gain authorization for a non-covered item or suggest a therapeutic substitute when necessary and appropriate.

Human Error:  This may happen either when a pharmacy technician or pharmacist failed to fill the order timely, accurately or appropriately once they received a ‘proper’ order.  Or, it could be that the health care facility sent an incomplete order to the pharmacy, failed to meet the proper ‘cut-off’ times established by the pharmacy.  Human error is also the most prevalent reason that medications are not able to be delivered on time.  GrandView uses routine competency check offs for pharmacy Data Entry and pharmacists to help eliminate any faults or unfulfilled orders due to human error.

In addition to the six barriers in preventing timely delivery of medications, we at GrandView, also realize there are ‘choke points’ along the way which delay the processing of orders.   GrandView management have recognized these ‘choke points’ and emphasize processing of orders, calling to insurance providers to gain clarity so that orders can be processed properly and efficiently.  Redundant internal procedures require Pharmacy personnel to call insurance providers continually until a resolution to a non-covered item is complete.  GrandView also calls again prior to release to get authorization from the nurse at the facility to release the delivery of the non-covered medication.  This familiarity with these processes breed expertise, thus allowing us to specialize in obtaining the medication for the facility and resident.  This also frees up the nursing staff at the facility to focus on resident care.

About the Author

Click here to learn more about Mark and the rest of the GrandView team.