Blog by Mark Wolfe, Customer Account Representative, GrandView Pharmacy
GrandView Pharmacy is in the business to fill prescriptions. That is what we do. GrandView Pharmacy wants to be sure that you have the medications needed for the clients/residents under your care. However, as you well know, regulatory compliance must be followed and sometimes these compliance issues can cause a delay in filling prescriptions to you on a timely basis.
At GrandView Pharmacy, we have procedures in place to handle six common barriers that often get in the way of timely medications. These are:
- Controlled Substances: Heavily scrutinized, it is getting tougher every day to fill these orders that require a ‘hard’ prescription. PrescriberConnect allows the prescriber to electronically submit for controlled substance prescriptions directly to the pharmacy. This is a more efficient manner to order controls than a manual process of calling and faxing requests. Encourage your prescribers to use this whenever possible.
- Order Clarification: Many times, pharmacy receives orders from facilities that are not clear or specific. In order to obtain authorization, the pharmacy needs this to be resolved before we can fill the order. If you can work with your prescriber and staff to help assure order clarification, that will improve the process time of the orders we receive from you. You can always call the pharmacy for assistance with unclear orders.
- Product Availability: Sometimes there are regional, or even a national back order. These are often due to production delay, demand exceeds supply, etc. Influenza vaccine or Mantoux Tuberculin are two items that come to mind. GrandView can usually borrow or buy from other pharmacies and/or hospitals to assure product is available for you, but there may certainly be delays for a specific medication. In that case, many times a different medication might be substituted until such time as there is a readily available supply.
- Refill Too Soon: Many times, insurance providers deny the prescription authorization due to Fill Too Soon; that is to say, that a previous order indicates has not yet been consumed. Usually if 75% of the previously filled order has been used, GrandView Pharmacy may obtain authorization from insurance companies to have the new order refilled. But such instances are not always authorized, thus causing a delay in completing the order request.
- Non-Covered Items: Your resident/client may have an insurance plan that may not cover a certain medication. In that case, as well as the Refill Too Soon detailed above, GrandView will contact the facility notifying you of the potential delay in filling the order request. They do this by either faxing a notification form to the facility, or by calling directly. There may be substitute medications suggested as alternative medications that are covered. Many times, the insurance companies require written authorization from the prescriber, or via the electronic Health Record. Either way, GrandView Pharmacy is to notify the facility of the reason for denial, offer a therapeutic substitute, or request a “Prior Authorization” from the prescriber.
- Human Error: Sometimes the facility staff makes a mistake; or, sometimes Pharmacy staff errors in processing order requests. These become teachable moments for the pharmacy to assure policy and procedures are followed and adhered to consistently. It may also be a teachable moment allowing the GrandView Pharmacy Account Manager to come to the facility to offer in-service training for best practice on how to order, re-order, medication.
GrandView Pharmacy will fax an NCI form, (non-covered item) to the facility. It is vital that the facility address this form. It could simply need clarification, need a prescribers’ prior authorization, or to accept a therapeutic substitute when the original medication was not covered by insurance.
No matter the reason for delay, GrandView Pharmacy wants to get you your medications in a timely manner. As indicated above, these are six common barriers to timely medication administration we see frequently. We understand that facilities have staff turnover. We also understand that you are frequently asked to do more with less. In-service or retraining may be indicated. We too, have staff turnover, but we work diligently to assure you have what you need for your residents/clients each and every day. Contact your GrandView Pharmacy Account Manager to schedule any retraining or reminder sessions to help streamline your process.
Further questions can be directed to a Grandview pharmacy representative. For Account Manager Mark Wolfe, please call 317-450-5723, or email at firstname.lastname@example.org. For Account Manager Charissa Widegren please call 317-771-3649, or email her at email@example.com.
About the Author
Click here to learn more about Mark and the rest of the GrandView team.