Preventing retail pharmacy calls to the office

A complaint often voiced by doctors’ offices is that retail pharmacies are constantly jamming phone and fax lines with prescription issues. Here are some suggestions to limit these burdensome communications:
  • Prescribe formulary options: If a prior authorization request is sent over, do not automatically sign and send. Research what the formulary alternatives are. Prior authorizations expire annually and there is usually a formulary equivalent that is just as effective. This will save time in the long run by preventing future prior authorizations from being sent. 
  • Update directions if changed: If you have updated directions on a medication (example, increase to twice daily or decrease to ½ a tablet), make sure you order a new prescription for the correct directions and quantity. If you do not, the pharmacy will contact you in a few weeks when the medication cannot be filled for various reasons (too soon, patient ran out early, appears patient is non-adherent, etc.). Also, add a comment that says “dose change” and request to discontinue the old prescription.
  • Prescribe 90-day supplies with three refills: Many of our medication orders in Epic default to #30 with three refills. If a patient is on a chronic medication, consider ordering for 90-days with three refills. Examples include statins, blood pressure medications and diabetic medications. The pharmacist is able to partially fill 30-day supplies if the insurance will not cover 90-day supplies, however, they cannot add a quantity. If you prescribe #90, #30 may be dispensed and two refills added. But if you prescribe #30 with 2 refills, expect a refill request in three months.
  • Encourage patients to enroll in automatic refill programs: It takes the guesswork out of patients remembering to call in their medications and you will only hear from the pharmacy once a year when all refills have been exhausted. 
  • Avoid “as directed” instructions and keep directions clear and concise: Pharmacies do not have access to Epic to determine your care plan. Make sure the directions are clear, concise and can be understood without needing access to the chart. Avoid the term “as directed” without additional details, as pharmacies legally cannot put these directions alone on prescriptions and will call the office for additional clarification. Examples are follows:

1. Blood glucose test strips
  • Wrong: “Use as directed” 
  • Right: “Use to test twice daily” 
2. Daily oral medication
  • Wrong: “Take as directed”
  • Right: “Take 1 tablet by mouth daily”