Just got into PhT at Walgreens, few questions.

[shooshh]

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I just got put into Walgreens pharmacy as a tech-in-training, but it isn't official so I don't have access to the PPLs. I do have a few questions regarding the IC+ system though since my trainers are not exactly helpful. I hope there are a few of you that have experience with it.

1. Scenario: Customer complains that the prescription costs too much. From what I have seen, the techs enter in different insurances and see which one will cost the least, but they go through the process too fast for me to follow. What is generally the process that I am missing here? Anything will help, really.

2. I don't get how the techs "just know" the insurance codes for when they are inputting the insurance card. Is there a list somewhere that I can learn all of these codes?

3. What do you do when a prescription is expired? I know that you are supposed to contact the doctor, but I don't understand the process. Also, what do you do if the doctor does not respond right away? I can't imagine telling the customer to just wait.

I'm sure I will have more questions, but I am pretty exhausted right now from a long day. I really will appreciate any information you guys can provide.

Thank you in advance.

 

[shooshh]

I also received a job offer at CVS, but I feel like Walgreens might be a better fit. Has anyone worked at both places that can give me their opinion on which is better?

Thank you.

 

[sunnybee25]

I've been working at Walgreens for about 1.5 years now, so I'll just share what I know/would do
1. If customer complains about the rx price:
Check pt central profile to see what insurance was billed previously and at what price for the same rx
If the rx was billed to the same insurance but has a different price: the patient could be undergoing a deductible or etc. something related with their insurance plan and not the pharmacy related.
If it is not billed to the same insurance: ask if patient has switched over to a different insurance recently, if not go ahead and bill the insurance you saw from their history
-sometimes patients have multiple insurances that can cover more or less than their primary insurance. one example is wcard which sometimes cover finasteride 1mg more than certain private health insurances

2. They "just know" from experience. There really is no point in making huge efforts to memorize any of it. Just whenever patients give you a card worry about three things: bin, pcn, and rx group. If none of those are listed on the card (sometimes happens) look at the title of the card and member ID. If all else fails just look it up under third party inquiry and enter the title.
Common ones easy ones
HNET, CABS, AETNA, CIGNA (should say on the card directly), PERX, WLPNT

Harder ones:
CAMED...just cause theres certain things you might have to change

I can't think of any for now but if you have some spare time, try picking up some prescriptions in the bin and look up their insurance profiles. Helps to learn and get used to the patterns
If you just search any plan on the third party option, they will generally tell you info to submit the claim to such as suffix codes

3. If rx is expired, it usually just says CL (closed). Refill it/enter it into the system. This will go into the workque as either WCB (will call back) or CMD (call MD, i think). Then let the patient know it might take a few days and if they are in dire need of the medication, ask the pharmacist if they can give an advance. BUT only for RX prescriptions. Nothing controlled. There are exceptions. Up to the pharmacists' discretion. I've seen a patient who got advances even for CIIs so its really up to the circumstance. As a tech, your are only able to ask the pharmacist and there really isn't much you can do. I've seen a patient whose doctor denied his refill and he stood there barking at me for 20 minutes and finally the pharmacist caved in and advanced him a few tablets.
I hope you know what an advance is...but if you don't...it is basically when a rx is awaiting doctors approval for refill or something and the patient is out. Then the pharmacist can advance(give) them a few tablets until the doctor responds. We then subtract that from their next fill.

When I started, I was quite overwhelmed. My Walgreens is one of the only two in the city that is 24/hr so we experience a large volume of customers all the time. But I also had great techs that taught me alot so if all fails, don't hesitate to ask for help. It only gets annoying when you ask the same thing OVER and OVER again. I've trained some new people and they always ask the same questions. So be attentive, detailed, and take notes if you must! You're new so no one expects you to be perfect, just work hard and learn as much as you can by asking questions. And lastly, don't expect other techs to help you with everything because they're busy too. So if a rejection comes back from an insurance company and tech says they need to call insurance to see what is going on...take initiative and call yourself. Will help you get used to solving insurance issues by yourself.

Further questions, feel free to ask me. I was searching all over the place for similar advice but no one had a thread or anything about Walgreens in specifics so I'm more than happy to share 🙂

 

[sunnybee25]

As for CVS...I've heard other techs say their system is super outdated. I also heard that Walgreens sold their system to CVS which was 5 or more years behind our new one so Walgreens is definitely one the more updated pharmacies.

 

[BlknOrange]

Sunnybee25 covered all bases pretty well. I've been at WAGS for a little over a year and I'll add some things on:

For question 1: When a patient complains about the price, I usually don't like asking if their insurance has changed because most of them will say no or will say it's always been the same but will be unaware if anything has changed, so I do the following...

-Glance at the leaflet and on the left side,under the barcode where you scan the RX, you should see the insurance abbreviation like "PERX" or the discount card like "WCARD". If it's there, that means it's billed under a insurance or discount card (from experience, you'll know as there are many types of insurance and coupons/discount cards). If nothing is there, that means it's the "cash" or out of pocket price.

--> If there's an insurance abbreviation, highlight the rx in the work queue, hit F8 for their profile and check the history of the medication. If it's the same and they haven't picked it up in a long time, they might've just forgotten the cost. If it's higher than last time, go back to the work queue, highlight the prescription, then go to options then "view claim info". It'll give you info if there's a deductible, initial coverage or coverage gap (Medicare Part D mainly), non branded or non formulary, etc. Sometimes no info will appear. From this point you can tell the patient what they'll need to do.

--> if no insurance abbreviation is present, go to "update rx" and select the appropriate insurance. Chances are it could be a third party reject (TPR) and it will tell you whether it is refill too soon and the date, or it requires a prior authorization or if you need to call the insurance for a max qty or anything else you need to adjust.

Insurance issues take awhile to get used to but eventually you'll get it. Once you understand it, the harder part is educating the patient so they don't yell at you lol, but that is sometimes unavoidable.

Question 2: Third Party inquiry is going to be your best friend for this one. Use the BIN and PCN to search (most of the time it's on the card), if not resort to using the title of the insurance. Some common ones like blue shield don't have it on their cards so ask your fellow techs.

Question 3:

Here's the basic workflow of what happens when an RX expires or is out of refills and you "refill" the rx: WAGS - electronic fax to dr's office-> Dr's office ---> returns Rx authorization or denial to WAGS. Here are a couple of pointers as well.

- RX's that are non-controls: Like Sunny said, you create a new RX/ "refill" it. it will go back into the queue as WCB and if there's a fax number for the Doctor's office, the system will generate one and send it automatically. Once the Dr's office sees it, they'll return the fax, call for more refills or a new RX, or e-prescribe a new RX. I wouldn't tell a patient to wait at all, instead ask them if they have more at home; if not ask the rph for an emergency supply and under his/her discretion, will authorize an advance to give them a few to last them.

Another thing to add, if they keep pestering you, you can call the dr's office and let them know that it's urgent. Sometimes they can give you refills right away or it'll come sooner later in the day. Depending on the time of day and your location, docs can return a fax or call before the end of the day, if not the next day.

-Controls: Depends on where you live according to state laws. I'd ask your fellow coworkers for this one and each Rph has their ground rules for these things.

Hope this helps and walgreens > CVS. I know a few people who worked there or are still working there, and wags has it better. It's still retail though and you will still experience things that are retail. *Whew*, PM me if you have more questions and I'd be happy to help!

 

[sunnybee25]

@BlknOrange

awesome fellow employee! What city do you work at?

 

[Ben Tsao]

I just got put into Walgreens pharmacy as a tech-in-training, but it isn't official so I don't have access to the PPLs. I do have a few questions regarding the IC+ system though since my trainers are not exactly helpful. I hope there are a few of you that have experience with it.

1. Scenario: Customer complains that the prescription costs too much. From what I have seen, the techs enter in different insurances and see which one will cost the least, but they go through the process too fast for me to follow. What is generally the process that I am missing here? Anything will help, really.

2. I don't get how the techs "just know" the insurance codes for when they are inputting the insurance card. Is there a list somewhere that I can learn all of these codes?

3. What do you do when a prescription is expired? I know that you are supposed to contact the doctor, but I don't understand the process. Also, what do you do if the doctor does not respond right away? I can't imagine telling the customer to just wait.

I'm sure I will have more questions, but I am pretty exhausted right now from a long day. I really will appreciate any information you guys can provide.

Thank you in advance.

I started working this past summer, so it have been about 4 month or so. My stores demographics contains mostly students, who, believe or not, have no idea how insurance work and often call their Ma and Pa on the smallest issue.
My advice is to:
1. Start off slow, but make sure you understand the IC+
2. As times goes by, depending on the state and region you live in, you will see the majority of insurance that covers your patient, try to get familiar with it
- For me, I work at Madison WI, so many of my patients are insured by Navatis (UW madison's prescription insurance); or Dean/ group Healthcare.....
3. Don't worry about knowing the insurance code, I was very confused at first. Just ask your pharmacists. I am very lucky to have a very supportive team behind me during my training and I got on to my feet very fast. Remember, our country's insurance is a big mess, and you are not responsible for this mess. All you can do is to try to get the best of it, taking step by step and learning.
4. be nice to people, tell them you are new and you are not sure. I got away with trouble often by being honest


Best of Luck.

 

[phathead]

As for CVS...I've heard other techs say their system is super outdated. I also heard that Walgreens sold their system to CVS which was 5 or more years behind our new one so Walgreens is definitely one the more updated pharmacies.

That's not true, WAG's system has never been sold to anyone else... that would be a remarkably dumb decision. IC+ is such a bloated mess it's almost unusable with their "enhancements" some days. That's what happens when you merely continually update a program over 15 years with no plans for a new system in the future. There are much, much better pharmacy software packages out there. What companies like PioneerRx is doing is amazing.

As for what to expect at WAGs... I'd just buy a lot of scotch. Things have gotten so bad we've had a mass exodus of really good pharmacists/techs the last two years. My RxM up and quit a month ago after being at our store for 14 years. It's rough and frankly not going to get any better because the executives in charge really have no idea how to run a pharmacy. Sorta like what they have done with our call lists or how none of the RxM's bonus are built around things that are controllable like your profitability...