Insurance Company and Prescription

Interviewing a Pharmacist

A prescription is written for you by your doctor by directly handing it to you in handwritten form or sends it electronically to your pharmacy. Such a pharmacy could be a mail order pharmacy, a retail one, or even a pharmacy at the doctor's office.

The pharmacy benefits manager inspects your insurance plan to ensure that the prescribed medicine is part of your insurance plan.

Your insurer will decide one of the following to facilitate your access to the prescribed medicine.

Once you make the co-payment indicated in the insurance policy for your medicine, you access the medication.

You access the prescribed medicine after executing a higher co pay or you can make part of the total payments; also referred to as co-insurance.

You could be given medicine that is less expensive but provides similar benefits as the medicine prescribed but isn't a generic of the prescribed medication.

d. Your insurance may ask you to try different medicine and only pay for the prescribed medicine after the one they suggest fails to be effective.

Step4: Your pharmacist will let you know the medicine you can access and the accompanying cost of such medicine. It is upon you, the patient, to choose the medicine to order; basing your decision on the prescription and recommendation the doctor has given you, your financial power to purchase the medicine and other significant factors you figure out.

Step5: You can pick up your medicine from the pharmacist physically or through mail posting. Sometimes, the pharmacist may be unaware of the amount you are paying for your medicine until the point of filing the prescription and cash register charge printout (Prescription Process, 2016).

Some common reasons why pharmacists often call providers to clarify orders

From a list of nine common reasons for callbacks to providers by pharmacists, the most common and frequent ones include prior authorization, missing dosages, just lack of clarity, and to check formulary details. In order to make it clear, the reasons for calling back were separated and placed in administrative and clinical categories. Calls that had to do with clarifying insurance status and cover limits, and those that had to do with pharmacy clarifications, including formulary issues, prior authorization and refills were considered administrative. All else was regarded clinical (Hansen, et al., 2006). Clinical issues include such aspects as dosages, instruction and qualities. Other clinical issues include

i. Ensuring that the dosage is appropriate and safe based on the age, weight and severity of illness.

ii. Making sure that the administered medicine is compatible with other medications and allergic conditions.

iii. Making sure that the medication is relevant to the condition under treatment.

Proper Prescription And Common Omissions On Prescriptions Received?

1. Details of the prescriber

2. Details of the patient including age, conditions, allergies and medical history

3. Medical cover details

4. Ascertain the medicines to be dispensed to the patient

5. Ascertain the indication

6. Check the details of the preference such as safety caps

7. Check whether the prescription is in line with the legal requirements such as dates and instructions.

Encountered Medication Errors

Errors noted in prescription include lapses, slips and mistakes spanning dosage writing, amount of dosage, confusion emanating from similar brand names, or even pharmaceutical titles.

It is notable that many of the errors can be associated with human factors. In the search for the conditions that make it more likely for errors to occur, it has been noted that unsafe environments are the most latent reasons for erroneous prescription. The Swiss cheese model by Reasons demonstrates the causation of accidents; systematic and sequential failures accompanied by insufficient defense mechanisms including counteractions are necessary for such an accident to happen. In the errors that arise from prescription, insufficient control of feedback or sheer poor coordination and cooperation between doctors and nurses have been cited as central factors. Unclear roles regarding who should be prescribing are also contributing factors that culminate in adverse implications. For doctors, issues that have to do with excessive workload, poor working environment and conditions, poor communication of the medical teams, and poor mental or physical condition are also significant factors that lead to prescription errors (Velo & Minuz, 2009).

Prior Authorization (PAR) process and common PAR medications

Prior authorization, also known in shorthand as PAR, is a common procedure in many medical health service provision environments. It involves the practice of requiring authentication before an insurance company covers outlined prescriptions. The practice is closely associated with "fail first" insurance policies. The policies often require clients to try less expensive options of medication before the insurer agrees to pay for the more expensive prescription outlined.