15 tips for a happy pharmacy!
1. Dont be afraid to help the techs. If you have nothing to f4 or product review or very few of each, don't be afraid to answer the phone or f1. You are not strapped to your station (unless it's a busy store, then you have no choice) so don't be afraid to help.
2. Go through the TPR's. It will help give you an idea of what insurance limitations are. For example, in my state, Cigna will only cover a 30 day supply of medication. I have never, ever seen a 90 day rx covered by Cigna. I only learned this through experiece. Learn what's on your state's Medicaid formulary. It should be online so you can view it from home. That way when you get a prior auth required on nexium, you can call the md and ask if they would like to switch it to a PPI that is covered or do a PA? The majority of the time they change the drug because they can't be bothered. Quicker and more efficient and gets the patient the meds faster.
3. Just because it says on the script "start taking on 6/3 and continue throughout 6/10" and you're filling it on the 5th doesn't mean you have to stop the entire pharmacy, try to call the office and speak to the doctor, only for him to be like lolwut? And then call the pharmacist in the store down the road and ask what they would do, only to finally fill the prescription without the date written on the directions. Thanks for wasting 45 minutes and backing everything up. Use common sense.
4. Scan in your own prescriptions. Don't hand them to someone else. It is very annoying and shows a lack of respect. Unless the tech offers to.
5. Don't make promises to something you can't fulfill. Telling someone that they'll get their prescription for free because the doctor's office messed up is a no no. They have to take that up with the doctor's office because you didn't do anything incorrectly. When in doubt, say you don't have the authority to do that and ask them to speak to the pharmacy manager.
6. Become BFF's with the market scheduler and when it comes to getting time off, you shouldn't have a problem.
7. Don't cap everything and anything. Review the patient profile first to see if they taken the medication before. If they have been on the medication, and you cap it just to have them answer the question "we have on file you are allergic to X, have you taken Q before?" the techs will be annoyed with you because the patient will respond that they've been taking it for 5 years now without an issue. Also, putting a cap on something to verify the DoB because the doctor didn't call the script in with one is annoying. Write a note on the leaflet and let the techs know to ask. Unless its a common name like Jane smith or if you have 2 people with the same name in your computer. Then you can cap it.
8. I'm not sure if you know this or not, but prior authorizations are a common issue. What exactly is it? The prescribed medication or dosage is not on the insurance's formulary (list of preferred drugs, which are usually therapeutically similar and cheaper). The doctor, or in most lazy doctor cases the medical assistant, needs to contact the insurance company and answer a few questions regarding why they are choosing this over certain other drugs. Usually these questions include if the prescriber has tried alternative therapies first, or if the patient has an intolerance to them, or blah blah blah. It's all out of your control, and the best you can do is contact the office and ask them to do the PA (usually a fax you send them). If the patient is giving you a hard time, offer to call the insurance and check the status of the PA. 9 out of 10 times, when you offer to do this, the office hasn't even started the PA yet. Tell the patient to contact the office. Takes the heat off of you though.
9. When you are training, ask what the most confusing insurance to figure out is. Medicaid in my state has 5 different looking cards, with 5 different names. Each one has no processing information on it, except the ID number, so the only way you can know if it's Medicaid is pure memorization.
10. When someone hands you an insurance card, usually there is an RX on the card to denote that the policy had prescription coverage. If the rx is missing, they usually have coverage through another company.
11. For ALL Medco claims (PAID), you require a 3 digit person code (001,002,003) at the end of the ID number and you MUST link to head of household in order for claim to go through. Most of the time, you can trick the computer by linking the person themself as the head of household. It doesn't check to see if you're correct, it just checks to see if there's a link.
12. Learn which companies require a group number, person code, and which don't. Write them down or remember to f10 so when you're alone at night and can't figure out why the caremark claim won't go through because you didn't put in a group number, you have something to reference. Also, f10 is your friend when you're learning insurances. It tells you if you need a person code or group number and all the basic stuff to get the claim to go through.
13. Read the reject field entirely. Sometimes you'll get multiple messages saying doctor not enrolled prior authorization required refill too soon until aug 13 12. Guess which one it is?! Refill too soon. It's usually the easiest problem to fix when you have multiple messages. Don't tell someone it's a prior auth when it's just refill too soon!! If you're not sure what the reject is, ask someone else! If you still cant figure it out, call the insurance.
14. When you call insurance, don't let them tell you they can't pull up the patient's information. Most of the time, they choose not to listen to you when you spell out the ID for them and they punch in different numbers and letters. Have them read the ID back to you, or the name and dob. I usually read out the Letters in the ID as M for Mary, N for nancy, Z for zebra, etc. It increases the chance they'll get it the first time. However, I have had people when I say M for Mary, still punch it in as N. sigh.
15. Finally, don't just put a msc on something and not tell anyone about it. This makes patients angry if you just tell them theres a problem with a prescription and didn't do anything to resolve it or attempt to resolve it. Tell the techs that this Rx needs to be called on to verify the drug, or dosing, or allergy interaction. Someone will usually call and try to get in touch with the doctor for you and then give you the call if you ask them to do so.
Always show that you made an effort to fix the patient's problem and they won't be as angry with you. Always use positive language saying, let's see what we can do for you. Let me look into this for you, etc.
Ps. IGNORE ALL RUDE COMMENTS. Most of the time, people who come to the pharmacy don't feel well and are cranky. They usually don't mean what they say. Just let it roll off your shoulders and joke about it with your coworkers later.