Whether you’ve never been to a pharmacy before or you’ve been to a pharmacy seemingly a million times, eventually, you’re bound to hit a snag and… you don’t know what to do.

 

If you’re not one of these people, that is awesome.

 

But if you are one of these people or the doctor just handed you a prescription and you have no idea what to do… this is the article for you.

 

If you’re new here, my name is Albert, I’m a pharmacist and chemical engineer and today we’re going to be talking about what to do at the pharmacy, and what to do when certain things happen.

 

And to encompass as many situations as we can, we’re going to do it from the perspective of someone who’s never been to the pharmacy before.

 

Step 1: GET A PRESCRIPTION

 

 

 

From the doctor’s office they’ll either hand you a prescription that’s printed on special tamper proof paper, or they’ll send it directly to the pharmacy using an electronic verification system.

 

A few main points here about prescriptions:

 

1. If they give you a paper prescription, it’s probably not regular printer paper. Paper prescriptions are required by law to have some kind of tamper resistant mechanism and that mechanism is usually in the paper so it’s a little thicker.
   
   
   It could have a state seal somewhere on it, like in a corner or on back. It could have one of those things you scratch with a coin to reveal an image. It could require a hot breathe to have a message or logo appear, and there’s several different types.
   
   
   Some States do use regular printer paper but they still have some type of tamper proof device on it. For example, some states will have very fine text somewhere on the paper. To my knowledge, I don’t know of a state that doesn’t have one.
2. Prescriptions don’t last forever, so it’s best not to keep them until you need them because there’s a good chance you might lose them. Prescriptions in most states last 12 months for “regular” prescriptions and 6 months for “controlled or schedule 2” prescriptions.
   
   
   Don’t know if your prescription is controlled? Well unfortunately there’s so many that… you’ll just have to know if yours is or isn’t and you can definitely ask the pharmacist if it is or not.
   Some common signs of controlled medications are the way their names end. If it ends in “-PAM” or “-ODONE” or “-AMPHETAMINE” it’s probably a controlled medication.
3. If the doctor’s office sends the prescription electronically, there usually isn’t a huge transit time. I’ve had some offices send me prescriptions in real time while I’m on the phone with them, within seconds.So if the pharmacy doesn’t have your prescription, make absolutely certain the doctor sent the prescription to the right place. You wouldn’t believe how often prescriptions are sent to old pharmacies, wrong pharmacy–same city, right city-wrong state.If the pharmacy can’t find you in their computer even if you’ve been there several times in the past, have them search by your phone number if that hasn’t changed in a while. I’ll be honest with you, contact information and your address is not always up-to-date. Most pharmacies are going to require 2 methods of identification and most people move more often than they change their phone numberIf you think you’re the only Rachel Anderson, born January 1st, 1977, you’d be surprised.

 

There’s a lot more to prescriptions, but this is more than enough to get started so… moving on.

Step 2: GET YOUR INSURANCE

 

 

The American healthcare system is unreasonably complicated. You have different insurance for different things: Medical, dental, vision, and pharmacy. And sometimes they all have their own cards.


How do you know you have the right one? Well there’s two obvious ways.

 

1. There’s pharmacy billing information on the card. At the doctor’s office, they do “paper billing” as in they’ll treat you first, and then figure things out with insurance later. That’s why you may not get a bill for weeks later.
   
   
   At the pharmacy, they’ll do electronic billing where they’ll submit it right after getting the prescription from you or your doctor. Because of that there’s some codes on your card to direct them to the right account, just like how you have a bank routing number to the right bank and a bank account number to find the right person.
   
   What this looks like on your card is: an RXBIN, RXPCN, RXGRP (or sometimes just group), and your Member ID number.
2. The second way is there’s simply a pharmacy help desk number on the back of the card somewhere. I’m not sure if this one is always the case but I haven’t run into an instance where it’s not.

 

If you have Medicare, it wouldn’t hurt to bring your Medicare Part B card which is a flimsy piece of red white and blue paper. On occasion, your Medicare Part B will actually cover some things at the pharmacy like some diabetes equipment and organ transplant drugs.

 

Step 3: YOU WAIT

Depending on how busy the pharmacy is, it could take some time.

Just a brief (and I do mean brief) idea of what the pharmacy staff is doing after you drop off your prescription. It goes a little bit like this:

 

1. You drop off the prescription
2. The prescription is typed out (manually if it’s a paper prescription)
3. Your insurance is billed
4. The pharmacist checks everything that they need to
5. The prescription is filled, meaning the pills are counted and put in a labeled bottle or a label is smacked on a box
6. The pharmacist checks it one last time to make sure nothing was missed putting it together
7. It’s packaged is stored somewhere for pickup

 

There’s several reasons why your prescriptions are delayed but the most common are:

 

1. Your insurance won’t pay for it and the pharmacy team is finding out why (sometimes in coordination with your doctor)

2. The orders before yours have an issue, maybe insurance, and regardless of if yours is as simple as slapping a label on it, there is a line to be followed, even if those people aren’t physically waiting at the pharmacy with you.

3. They’re simply very busy. They might not be able to even get started on the line of prescriptions because they’re on the phone with your insurance, someone else’s insurance, a doctor, or another patient. To put things in perspective, I’ll answer 70-80% of all phone calls personally sometimes so the rest of my staff can focus on production.
   
   Remember, when you call in, or you ask for advice, we’re happy to talk to you, that’s the best part of the job, but just know that the same people you’re calling are the same people filling prescriptions. We don’t have a front desk like your doctor’s office. If you’d like to help them out (in general), please use any automated service when you can. It’s usually faster for both patients and providers once you get the hang of it and from experience the more technology pharmacies introduce to their workflow, the more man power they take away.

 

Step 4: PICK UP YOUR PRESCRIPTIONS

 

Please come pick up your prescriptions. There is a limit to how long a pharmacy can have your insurance billed and just for regular housekeeping, they’ll put things back after typically 10-14 days depending on which company or pharmacy. NOW, if the cost sounds unreasonable, there might be a reason why. Let’s go over some common reasons.

 

1. Your insurance has a deductible. If you’re unfamiliar with what a deductible is, it’s an amount you have to pay before insurance will start picking up the majority of the cost. If you have a big deductible, it’s likely your monthly premiums are much lower. It’s a balance.
   
   
   If you’re a dependent, meaning someone else is paying for your insurance like your parents, you might have a shared deductible where anyone in the family can contribute. If you want to know details, call the number on the back of your card. I’ve called several insurance companies on behalf of patients before and plan and member data has been refused to me several times, because I’m simply not the patient.
2. Your insurance doesn’t cover the medicine. Insurances have formularies which is a giant list of drugs that they cover. If you’re on a state sponsored plan like Medicaid, you’re likely able to Google the most updated list but the pharmacy will also receive a message telling them the medication isn’t covered when they try to bill your insurance.
   
   
   There’s 3 things you can do in this scenario:
   1. You can have the pharmacy start a Prior Authorization or sometimes they’ll refer to this as a “PA.” What this means is that they’ll notify your doctor that the medication isn’t covered and that the doctor should contact your insurance to more or less persuade them to cover it.
      
      Just know that this can take several days to weeks which sucks if you really need the medication NOW, but if it’s something you can wait for, it’s worth a shot. Just remember the pharmacy has no influence on the PA, they’re just waiting back from the either the Doctor or the Insurance company for a result, so they can attempt another billing.
   2. Have the pharmacy request a different medication that is covered by the insurance and does the same thing. Easiest solution by far from a patient perspective. Again, if you’re on a state sponsored plan, the clinic should be able to look up what medications are covered before sending in a prescription.
   3. Use a coupon. There’s a bunch of discount cards out there… GoodRX, SingleCare, RXSaver, some pharmacies will have their own. Don’t pay full price for your prescriptions, these discount cards can sometimes save you like, 80+%.
      
      Also, please don’t be offended if the pharmacy refuses to look up a discount card for you, they’ve likely been told by their corporate not to use a coupon unless presented to them. In which case, just go to one of those sites and find one.
3. Your medication is just REALLY expensive. Either because you’ve chosen or your employer offered you a horrible insurance plan, or the medication is on a very high tier of coverage, or it’s a brand name medication and it’s intrinsically expensive.
   
   
   Luckily if what you’re getting is a brand name medication where a generic likely does not exist, it’s possible to get a manufacturer coupon directly from the company that makes the drug, that reduces the cost by a CONSIDERABLE amount. Just find out what company makes the drug, go onto their website and fill out some info. Just know that a lot of these coupons do not work with government funded plans which include both Medicare and Medicaid.

 

Step 5: Your Medications Weren’t in Stock

 

Not really a step, just something that happens from time to time. They should have told you this when you dropped off your prescription so that’s on them if you made it this far.

 

Most pharmacies have a 24-48 hour promise time by their wholesaler for most medications. Some medications like controlled medications may take a bit longer.

 

For the past couple years there does seem to be some outrageous drug shortages on a manufacturing level which makes it very hard for ANY pharmacy to get the medication. However, it’s still worth it to call around to other pharmacies to see if they have it. Just know that there are some legal restrictions to transferring prescriptions from store to store in certain states, even within the same company.

 

OUTRO

Well that’s everything you need to know for your first trip to the pharmacy. If I missed something you’re wondering about or if there’s something else that happens and you’d like to know the most likely reason because it’s unclear, shoot me a message and I’ll let you know.

 

Thanks for tuning in today, I hope there was something new for anybody. If you’ve enjoyed the content please consider subscribing to our newsletters and I’ll see you next time!

 

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