Darius Randeria R.Ph ; BPharm (London) ; M.R.P.S
Vice President, Staffing
If you could write a letter like this, what would you add? What would you take out?
We have been working together for about a century now and have seen healthcare change many times while you and I have continued to take care of the patients as best we can. We haven’t talked in a while and I just wanted to touch base with you about a few issues that would help our relationship.
On the subject of cost and insurance, I know that you hate to do prior authorizations as much as I hate to present a bill to the patient for a drug that is in excess of a week of their income. You and I need to work together so that the PBM companies do not control what drug a patient gets. However, you and I both know that we need to reduce unnecessary healthcare expenditure and so I wanted to ask you and your staff to please think about the patient’s ability to pay for a medication when you write a prescription. I encourage all patients to bring their formulary book with them when they see you and I hope that you do the same. There are literally thousands of cough and cold preparations that all contain differing formulations of about 10 total active ingredients. We cannot stock them all and under current laws, we cannot substitute a therapeutic alternative.
On the subject of designated agents in your office, we understand that you are busy and need to delegate clerical duties. Sometimes, when we have to communicate with your office, we do so with a variety of disciplines. Sometimes it is a PA or FNP, sometimes a nurse or LVN, sometimes a med tech and sometimes an office worker. It is not uncommon for the subject of our call to be a drug interaction or other clinical question that needs a clinically trained professional to discuss it. As you and I speak less and less, please ensure that you have appropriate safeguards in place that prevent decisions being made without your knowledge and involvement.
One of the most difficult challenges facing a retail pharmacist is the prescription drug addict. You know about Doctor shoppers and pharmacy shoppers and I am sure that you know that this problem is growing every day. Please spend some time establishing guidelines so that we can communicate about suspicious activity and ensure that any authorizations for refills are only done under your direct supervision.
Refills are authorized in a variety of different ways. Some are requests via the patient through the pharmacy, some are from the patient directly with your office and some are done without any request by a member of your staff. Refills are a way that you can provide a specific duration of therapy for a patient in between monitoring and office visits. It is important for your office staff to keep up with them as we now have a system that allows patients to put unneeded refills on file for a later date. Sometimes we receive a new prescription with multiple refills when the patient still has multiple refills left. This leads to the question of when, exactly, this prescription should end. Do we cancel the refills already on file and start over with the new prescription? This does not usually happen as most pharmacies simply put them on file, leading to multiple active prescriptions for the same drug.
Communication is usually written or oral. Written prescriptions need to be legible. If not, we have to call your office. This delays the patient from getting their medication. Poorly written prescriptions also lead to errors. Oral prescriptions need to be written down by the pharmacist. They are often dictated at a speed that prohibits their transcription. Please ask your staff to speak slowly and clearly and make sure that they know the name of the drug themselves before they call it in.
Lastly, please spend a few minutes one day researching what is required to become a pharmacist. It is a six year degree and requires very high levels of academic excellence to complete. We are sometimes limited by the devolution of the “Practice” of pharmacy but we want to re-invent our job description so that we can do what we were trained to do which is to be an expert in medication therapy. You and I have the same goals and I want us to understand what each other does.