Drive-Thru Etiquette

While working in the handful of pharmacies I have covered shifts in beyond my own store, I have yet to meet a pharmacy staff member that likes the drive-thru. The drive-thru ends up rushed, forces priority to the people in the drive-thru to get them in and out, problems must be hastily corrected to provide timely service, and increased stress is placed upon the staff to serve both the customer who expects to come and go in the drive-thru and the customers in the store. However, drive-thrus will remain as long as big chain retails have pharmacies.

Drive-thru lanes have a time and place for customers and they are not always the appropriate option depending on the situation. Sadly, not all customers respect drive-thru etiquette and their problems not only prolong their stay at the pharmacy, but also the line of customers behind them. Certain problems can be avoided while others may require more time than the drive-thru allows.

An issue with the prescription fill

• Be willing to come inside the pharmacy or go around. Inside the pharmacy the pharmacist can take more time to explain the situation to the customer and how to solve the prescription problem. Sometimes the prescription simply has not been filled yet, but if we must fill four medications that will take time and the rest of the customers in the drive-thru line do not want to wait as well.

If the doctor was supposed to call/fax a prescription ahead of time

• Call the pharmacy ahead of time and make sure the prescription is already filled. Prescriptions are filled in the order they are received. However, prescriptions brought in to the pharmacy and waited on by other customers take priority. Though your doctor may have called the prescription in three hours ago it may not have been filled yet because the pharmacy has not had time. A call ahead will ensure the prescription has been received and will be placed higher on the list to be filled.

Most pharmacies with a second drive-thru lane is drop off only

• The air powered chute cannot handle heavy prescriptions and may get stuck. While some of the lighter prescriptions may be able to go through the chute, the pharmacy does not wish to risk having a prescription stuck leaving the customer without medication and the chute broken for future customers.

Do not expect to wait in the drive-thru

• Refills may be requested in the drive-thru, however customers cannot wait in the drive-thru for the prescription to be filled. Pharmacy drive-thrus are like fast food drive-thru's. The fast food place may ask you to pull around while the food cooks, pharmacy is no different.

The drive-thru is not for shopping

• The pharmacy staff member may be willing to grab an over the counter (OTC) medication to purchase with the prescription, but do not expect them to also grab you a gallon of milk and a handful of other items.

Other customers are waiting inside

• The pharmacy is well aware of the customers in the drive-thru. However, often other customers are also in the store that must be attended to as well. Be patient, a pharmacy staff member will be with you as quickly as possible.

Prior Authorizations

Prescription prior authorization (PA), the insurance rejection that forces me to cringe every time I read it. Prior authorizations are requested by the insurance company and not the pharmacy. However, the pharmacy usually ends up catching the flak as agitated customers stand confused as to why they cannot pick up their prescription that day.

Here's the scenario:

Me: "Your insurance is rejecting the claim for the prescription. They want a prior authorization from the doctor before they are willing to cover the medication."
Customer: "What? But I need my medication."
Me: "I understand and we are willing to fill your medication, but the doctor needs to complete the prior authorization with the insurance before the insurance is willing to cover it if they choose to authorize the coverage."
Customer: "You're holding the prescription in your hand! The doctor must think I need to be on the medication if he wrote the prescription. I need that prescription filled today."

When faced with a prior authorization the pharmacy cannot do anything to force the insurance to cover the medication. The pharmacy will be more than happy to fill the medication, however, if the customer chooses to pick up the medication prior to the authorization the customer must pay for the medication cost in full, or "out of pocket." Too frequently the cost of the medication is insanely high and the customer leaves without the medication. If the customer chooses to pay for the medication out of pocket and the insurance company declines to cover the medication after review, the customer remains stuck with the full cost of the medication which cannot be returned.

The Solution

Though prior authorizations cannot be avoided if the drug is not on the customer's insurance formulary, customers can ease the process by walking in to the pharmacy prepared. First, the customer should understand the basic process of a prior authorization.

1. The prescribing doctor must contact the customer's insurance company via fax or phone and explain why the customer must be on the prescribed medication.
2. The insurance company evaluates the prescription and current medications to determine whether or not the company chooses to cover the medication
3. The insurance company contacts the doctor to inform whether the authorization has been approved or denied.
4. If the authorization has been approved the pharmacy may now resubmit a claim and charge the customer the proper copay according to coverage.

Many insurance companies offer information on what triggers a prior authorization and the forms required by the doctors on their websites. These forms can be printed prior to the doctor's appointment if the customer already knows that the doctor may prescribe a medication not on their formulary. That way the doctor can initiate the authorization before the customer even walks into the pharmacy. Understand, however, that most authorizations take a minimum of 24 hours and more likely in the 48-72 hour range before approval or denial.

Some Major Insurance Prior Authorization Sites

• Caremark
• Medco
• Blue Cross/Blue Shield of CA
• Humana
• Cigna (PDF)
• Tricare
  

Prescription and Medical Insurance Are Different

When customers bring their prescriptions to the pharmacy, I ask if they have insurance. Too many times the customer produces an insurance card, but it is their medical insurance card and that company does not cover the customer's prescription costs. Here is the scenario that too frequently plays out:


Me: "Do you have insurance?"
Customer: "Yes."
Me: "May I see your insurance card?"
*Customer hands me his insurance card that I proceed to look over*
Me: "Did they provide you with another card for your prescription coverage? This only covers your medical costs."
Customer: "No. That's the only card they sent me."


At this point I can do nothing for the customer other than to suggest calling their health benefits manager and find out which insurance company covers their prescriptions. The customer never enjoys hearing this and often it leads to yelling or statements such as, "<Different pharmacy> has always been able use this card!" No, the other pharmacy had no use of that medical card and they must have found the customer's prescription information through some other means.

The Solution
The best way to avoid this situation is through basic insurance card education. Insured individuals should always carry their insurance cards with them, but before cramming it into the wallet take a minute to read the information on the card. Generally the information will be presented in one of three ways.

Cigna Insurance Card

If the insurance company covers prescription costs along with the medical coverage the letters Rx will be printed somewhere on the card.

United Healthcare Insurance Card

 






Sometimes the insurance company does not cover prescriptions but prints the information of the company that does on the same card.

Caremark Insurance Card

Other times a different company handles the prescription coverage and in turn provides their own prescription card.






 


 Regardless of the insurance company, the pharmacy is looking for four pieces of information.

• RxBin - the Bank Identification Number routes a claim towards the right insurance
• RxPCN - the Processor Control Number further narrows the claim to the specific insurance
• ID - the member's designated identification number
• RxGrp - the prescription group number denotes which group plan the member ID falls under

With those four numbers the pharmacy can properly submit a claim to the right insurance. If the insurance card does not have Rx or RxBin somewhere on the card then the card most likely is not their prescription card and the customer needs to hunt that information down.

First the Author

Welcome to Understand Pharmacy!
I wish I could disclose my personal information to you, but under the Health Insurance Portability and Accountability Act (HIPAA) I am not allowed to reveal my identity, who I work for, or any specific information pertaining to my customers. I will, however, say that I have worked as a pharmacy technician for a major chain pharmacy for over a year and continue to work full time. As a technician I continually learn the ins and outs of pharmacy which surprisingly has to do with much more than just filling a bottle with pills. Through the filling process, a handful of obstacles must be overcome from the point a customer drops off their prescription to point of sale. Too many obstacles result from a breakdown in communication or poor understanding and pharmacy education.

I do not aim to merely rant on this blog, but instead relay the all too common experiences that occur in the pharmacy and provide a means to alleviate the situation. These experiences will be provided as an example foundation to introduce a problem and provide a solution to the problem. Through this problem/solution scenario I aim to not only provide insights to what actually goes on behind the counter, but also improve future experiences of both the customers and pharmacy staff.

As a further disclaimer I do not aim to belittle any person or lay blame on either party involved in examples. My information will be based upon actual occurrences in the pharmacy and any further research necessary to provide a means to avoid such situations.

Enjoy.