PIEDMONT ACCESS TO HEALTH SERVICES, INC.
Policy Number: 01-13-003
SUBJECT: Filling Prescriptions
EFFECTIVE DATE: 07/13/2012
REVIEWED/REVISED: 10/24/2013, 11/21/2014, 06/14/2016
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POLICY: PATHS’ Community Pharmacy will comply with all regulations, including those mandated by the Commonwealth of Virginia, Department of Health Professionals, as they relate to the process involved in filling prescriptions.
RX Filling Process:
To Date
Rx Workflow: Register—Technician
Data Entry—Technician Rotate Technicians Daily
Label/Count— Technician
Verify—Pharmacist
REGISTER TECHNICIAN
A. New Written Rx
1. Verify name and DOB with patient—in NRX look patient up by their DOB and have patient verify address and phone number.
2. Ask patient any medication allergies (penicillin, etc…). Do you have insurance plan that helps pay for your Rx? Always get card if new.
3. Prior to scanning Rx, glance over Rx for discrepancies, drug name, date of Rx, Quantity, signature of provider, etc…
4. Scan Rx.
5. Verify waiting or coming back to pick up and NOTE in area available BEFORE you hit save.
6. Pass to data entry along with Rx in appropriate basket
B. Walk in request refill with bottle at counter
1. Before patient leaves, make sure a PATHS bottle along with refills available
a. Our bottle and no refills
i. First check in computer by patient date of birth to verify that a new rx for that medication is not on profile. If no profiled rx, inform patient that we will contact provider/it could be up to 72 hours or less before we hear back, but our system will call to inform them when rx is ready. Confirm patient’s info.
b. Not our bottle and refills
i. Get ALL patient information name of pharmacy and phone number/insurance/phone/etc. Pharmacist will call and get rx transferred to this pharmacy.
C. Patient on phone needing refill, but does not have RX #
a. Look up patient by their date of birth/pull up profile/find RX
b. SEND BASKET AND INFO Data Entry
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DATA ENTRY (Responsible for all data entered relating to Rx)
A. Prescriptions waiting to be filled can be found:
1. New Electronic Prescriptions=New Rx from Provider
2. IVR Refills-Rx# patient has sent in to be filled
3. Refill responses=Refill denied or refill approved or
4. Prescription Intake-Written new Rx scanned at pharmacy window
5. Refills bottle or called in by patient.
B. New written from prescription Intake (scanned) steps:
1. Verify Rx has no discrepancies
2. Verify correct patient: Always use date of birth (DOB) PERSON WHO SCANNED Rx may have chosen wrong patient
3. Verify if patient is 340 B eligible
4. Pull appropriate medication from correct stock (wholesale or 340 B). 340 B has a *within drug name and states drug type. (340 B in computer system)
· Always check patient profile for duplicate medications and date of previous fills.
***** Before you fill Rx—double check your information entered by comparing to prescription given to you to fill.
· After verifying correct, fill Rx.
· Place medication with corresponding Rx in basket and pass to next technician.
5. If a discrepancy is found on Rx, correct by verifying with provider or nurse. Note on the Rx the correction along with first and last name of who you spoke to, your initials, and the date.
LABEL/COUNT TECHNICIAN
A. **** Before counting you must double check what you have been given from data entry:
Written/eScribe/Refill Response—use your computer if necessary
1. Correct patient
2. Correct provider
3. Correct medication
4. Correct signature/quantity/refills
5. Correct NDC#, etc…….
B. If not, give back to data entry to correct!
C. Check, check, and double check before passing to pharmacist.
D. Once counted, bottled, and labeled, back tag on Rx if applicable. All receipts patient leaflet, bottles, and prescriptions are same name and are correct.
This process in a system of checks and balances. After going through three (3) sets of eyes, there should be no errors on the label. Third party issues must be taken care of, meaning, those issues you have been told that you may correct. Any questions always ask pharmacist on duty.
If Rx has to be verified with provider or nurse and already assigned a Rx# after corrections made to that Rx needs to be rescanned along with corrections(s)/who you spoke with (first and last name)/the date, and your initials.
In RX NOTES make a notation of “correction made.”
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THIRD PARTY PRESCRIPTIONS PROCEDURE:
A. Adding new Insurance Card
1. Under Third Party Price Plans—Parameter Information—Transmission Options
· Make sure the box next to “Print is $ Paid is < Acquisition Cost: is Unchecked.
B. “Electronic Claims Log”
2. No label and the claim is marked “Paid”:
· Check for lower-case “a” beside the claim line in the log. If “a” is present, the total adjudication and copayment are less than the acquisition cost of the prescription.
· If the total amount paid is less than acquisition by $19.99 or less, continue with filling the prescription.
· If the total amount paid is less than acquisition by $20.00 or more, reverse the claim and notify pharmacist. The pharmacist on duty will review the issue and either contact the payer directly, or seek support from PATHS’ administration. In the event that it is decided that the pharmacy cannot fill the prescription because of the loss, the claim should be reversed and voided from Pioneer POS.
C. If the claim is marked “rejected”:
1. Open the claim and review the information provided in the “Messages.” “Free Text Message(s) from Third Party” and view DUR.
2. Address issues accordingly. Once addressed, select “correction.” make changes and resubmit the claim. Repeat the steps outlined above.
3. Refill too soon. Reject. Read—other pharmacy? Day supply? Check if filled here. Go back to verify day supply was entered correctly from previous fill.
****Rejected due to a DUR and will not allow payment. Give to pharmacist. Do Not Override!!!
MEDICATION SHORTAGES
A. When a prescription, new or refill, cannot be completed due to any of the following, REVERSE the fill and notify patient explaining situation and giving the expected date of arrival: (NO EXCEPTIONS!!!!)
1. Inadequate amount available on shelf
2. Manufacturer cannot supply
3. Warehouse shortage
4. Warehouse miss pick
5. Error in ordering
REFILL RX
A. Patient is unable to wait for the medication to arrive:
1. Offer to transfer the prescription to the Pharmacy of their choice.
2. If patient opts to wait for medication. Give patient a reasonable time that the prescription will be ready for them to pick up. Gather any important info that patient states (please call patient etc.) and enter this info along with RX# and estimated date and time of pick up into Tickler.
NEW RX
A. If out of stock inform patient and offer to order giving date of expected arrival.
B. If patient needs to fill today RETURN WRITTEN RX to patient if E-SCRIBED offer to TRANSFER to pharmacy of choice.
REGULATIONS FOR USING MEDICATIONS FROM 340-B
This Pharmacy has 2 drug inventories: Wholesale and 340-B stock. These two inventories are physically kept separate from each other in the pharmacy.
Pharmacy employees are required to fully understand all circumstances surrounding the use of 340-B medication for prescription.
A. Requirements:
1. Prescription must be written by a PATHS provider located at any of the PATHS locations (Martinsville, Chatham, Danville, Boydton)
AND
2. Patient does not have or has prescription coverage that is not one of these listed below:
Name of MCO / BIN # / PCN # / RX GROUP #VA Medicaid / 010900 / DRVAPROD / (BLANK)
Anthem Healthkeepers Plus (FAMIS) / 003858 / A4 / WLAA
or WXAA
COVENTRY Cares (FAMIS) / 610014 / CVTYMCD
INTOTAL Health (FAMIS) / 004336 / ADV / 4294
MAGESTACARE (FAMIS) (FAMIS) Carilion Clinic / 610591 / A4 / 8816
OPTIMA Health (FAMIS) / 610011 / OHPMCAID
VA PREMIER / Envisions / 009893 / ROIRX / V7HA
These insurance codes are loaded in Pioneer and Pharmacy Staff is to check by looking at patients’ insurance information to verify NOT included in the above list in order to fill claim with 340-B inventory.
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INSURANCE CARD ENTRY
Pioneer has all PATHS’ Approved 3rd Party Insurances or Coupons pre-loaded into their pharmacy software.
SIGNATURES:
______/ ___ /______
Pharmacy Director Date
______/ ___ /______
Chief Operating Officer Date
______/ ___ /______
Chief Executive Officer Date
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