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Thursday, February 18, 2010

Mail Order Prescriptions?

Mail order prescription service is now 6.7% (as of 2008) of all retail prescriptions sold in the U.S. That's 238 million scripts...and growing.

Want to know what happens--and the pitfalls along the way--when filling your prescription through mail-order? Well, follow along.

1) You've got the prescription from your doctor. You need to contact your PBM (that's your Prescription Benefit Manager which you probably think is your insurance but really is a partner with your insurance). The largest PBMs are Express Scripts, Caremark, and Medco. They will send you a form--maybe you already have it--for you to complete and send in along with your prescription. But wait--before you lick that envelope take a good look at that piece of paper. (It would be better to do this at the doctor's office, but if your already home, don't worry.) Looking at the prescription, does it look right to you? Any mistakes? No? Good, but it's a good idea to fill in your address, or better, write it on the back of the prescription along with your phone number and date of birth. Also, any allergies or any information that would be pertinent. If you did find something wrong, call the doctor and have them fax the correct prescription to the PBM/mail-order company. If your doctor agrees to fax prescriptions (almost all do) you can save yourself some time and trouble and just have the doc do that when you're at the office. Just be certain you have the correct fax number. Double check them!

2) So you've sent out the prescription. What actually happens to it? First it gets scanned into a computer system, front and back, along with everything else that came in the mail: order forms, even the envelope! Data entry technicians then enter the information from the scanned prescription (they're looking at a computer image, not the actual piece of paper, which is filed away). Now do you see the importance of a well written or typed prescription? Any ambiguity here gets put into the computer and if not caught will result in your not receiving the correct medication. Good handwriting counts! Also, if the prescription is clear and read easily you will get your medication in a much shorter time interval than one that has to be sent back to the troubleshooters who then have to call or fax the doctor and start all over again. The prescription is then sent on to its next station, DI (Drug Interaction). There it is screened by pharmacists specially trained in drug interactions for any possible problems that might occur with other meds you are taking, even over-the-counter medications (be sure to fill out all the information on the forms: think pain relievers, herbals, vitamins, diet pills...anything).

3) If and when all the problems are taken care of the prescription then goes to the insurer who if they agree to pay for it then sends the prescription back to a pharmacist verifier, who compares the prescription image with the entered data. If it matches up fine it goes to a fill center, often not even in the same building as the pharmacists checking the prescription. Do you picture these places as giant warehouses where pharmacists are busy counting pills by fives on counting trays? Um, no. They are giant, though: Medco has one that is about as large as six football fields. Express Scripts--the nations largest PBM--has one coming online next April that will fill 110,000 prescription in a single day! But not by hand. By robots. These places all fill by robotic machinery: it's safer and faster.

4)The prescription once it is filled is put into a shipping container and put in the mail.

From start to finish it should take two weeks. But that is IF there aren't any snafus along the way. The most common reasons for longer waits are bad handwriting and errors by doctors. If either occurs then the pharmacists or technicians --or both-- have to contact the doctor and that can take days. That's the reason you should give the prescription a good look-see before you send it off. Errors are very common. Very. Saves you time to look before you send it out.

One caveat: if you're sending out a prescription for a control drug, DO NOT CHANGE ANYTHING ON THE FACE OF THE PRESCRIPTION. It could be considered as altering a controlled prescription, which is a felony. Not a smart thing to do. Better to write something down on the back of the prescription, or attach a note.

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