Tuesday, July 08, 2008

Naples Daily News


Guest commentary: A primer: Here's how your local pharmacy operates
By JEAN-MARC BOVEE, Special to the Daily News Sunday, November 27, 2005

I began working retail pharmacy 13 years ago and I, along with all of my friends in pharmacy, have been having the exact same arguments with people and have been continuously explaining precisely the same things during our entire careers. It seems that there is a persistent unfamiliarity among the populace concerning the inner workings of pharmacies.

This is not to say that people are to blame, they simply have never been informed; that is the intention behind this article. It is only a microcosm in the vast universe of pharmacy, but it will cover a couple of the more common issues.

The question most often asked of retail pharmacists is what the cost of the prescription will be. Please read carefully because this is important: We can only give you the cash price of the medication before we fill it. If you have insurance, then we cannot tell you the price until we actually fill the prescription.

Here is how it works: We first have to enter your personal information including your prescription insurance info into our computer. We then type the prescription into our computer, our computer electronically transmits your prescription to your insurance company's computer, which then processes the prescription and transmits the price that we are to charge you to our printer.

Only at this point do we know the cost to you, but it takes time as you can see and we have not even physically filled the prescription yet.

Prescription insurance companies are the main reason for your extended wait times. Now, if upon hearing the cost you feel that it is incorrect, then you need to contact your prescription insurance company. Remember, they are sending the cost to you, to us.

We have essentially no say in what you get charged. Simply call the 1-800 number on the back of your card and they will be able to directly answer all of your questions; they can even give you the price before you go to the pharmacy. Again, they set the price, not us.

You may have heard the words "prior authorization" at the pharmacy at some point or another. This is the latest trend in third party over-stepping. Basically what your prescription insurance company is saying is that despite the fact that your doctor wrote the prescription him or herself, they still require that he or she call them on the phone and authorize it.

If that does not seem to make any sense to you, do not fret for it does not make much sense to us either. What we do is call the doctor's office, tell them we need a "prior auth," give them your insurance's phone number, and then wait for them to call us back with the authorization so that we can transmit your prescription through the insurance.
It sounds like a blast, doesn't it?

Just remember, this is the mere tip of the iceberg, so to speak, or write.

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