How your pharmacy works

Much of what happens when you have a prescription occurs behind the scenes.

When you bring in a prescription, or if we call or fax it for you, the medication is labeled, placed in a secure bottle and checked against other medicines you obtain through that pharmacy to be sure that it is safe with your other medicines. The pharmacy also provides verbal and written instructions and precautions about the medicine.

When you need a refill, they provide this by phone and in many cases on-line through a dedicated website.

Even when the bottle says that there are no further refills, a call to the pharmacy will take care of this.

What happens is that they will fax me a request to okay any refills. We respond by faxing them back within 4 hours or less of receiving the request.

Mind you, we may also contact you if we notice that you are overdue for an annual physical or a follow-up appointment for a chronic medical condition. We may also wish to see you first if you are requesting a refill on a medicine that was prescribed a long time ago (such as a pain pill for a condition that went away a few years ago).

Because of the contracts that pharmacies have with commercial insurances (such as Blue Shield, Anthem, United, etc.) they can only fill prescriptions for 30 days at a time. I'm sure they'd be happy to be able to fill more at once, but if they do the insurance won't pay them for the medicines.

The reason for this is that the insurance companies have out-sourced discount contracts for medicines to Pharmacy Benefit Managers (PBM's) or "the mail order pharmacies" such as MedCo and Express Scrips. These companies are contracted with your insurance to contract with drug companies to provide discounted prices for large-volume buyers. In other words, your insurance saves money on medication costs by getting discount rates and requiring you to use them if you want to get more than a month's supply of medicines at a time.

You may use your insurances PBM by looking through the materials they send you every year, or by calling them at the toll-free number on your insurance card. They will provide you with any necessary paperwork. We can provide a 90 day prescription with up to a year's worth of refills if you ask. When this is sent in, they will mail 90 days at a time for up to a year to your address.

Do realize that you probably should not use the 90 day option for a new pill or a change in the dose, until we know it's working well and not causing you any problems.

Also, be aware that the military (CHAMPUS, TriCARE) operates differently. If you have no insurance, WalMart will fill many prescriptions for $4/month or $10/90 days. Just let us know which one you need when asking for a prescription.

Mail Order Pharmacy

Mail order prescription services are known to your medical insurance companies as Pharmacy Benefit Managers (PBM's).

PBM's are middlemen that obtain contracts with pharmaceutical manufacturers ("drug companies") for discount prices on large sales volumes for the insurance companies. In theory, this is supposed to be a win-win situation for everyone. The insurance companies save money on cost of medications, they incentivize you to participate by lowering the out-of-pocket cost of your pills, and otherwise pass on the savings to you.

Of course, you could reasonable ask why your premiums keep going up, but that's a topic for another time. You might also ask what that's doing to your friendly and trustworthy local pharmacist, but I guess the idea is that it's a tough old world out there.

If you want to use your PBM, and would like our help in making it work for you as smoothly as possible,

• They will usually send you a renewal form for each of your medicines when your yearly prescription is up.
• Please let us use these for renewals. Using hand written prescriptions for renewing already existing prescriptions is very confusing to them.

• PLEASE, PLEASE USE YOUR LOCAL PHARMACY FIRST FOR NEW MEDICINES OR FOR CHANGES IN DOSES ON MEDICINES!
• It's not unusual to start or change a medicine, only to find that you have to switch to something else because of side-effects, or that you have to make another change in dose at the follow-up visit.
• Because of this, it's a good idea to make sure that the medicine and it's dosage is right for you before getting 3 months worth for a year!
• Yes, we know it's cheaper to do mail order.
• Yes, we know a few dollars is a lot of money these days, especially if you are on a fixed income.
• The problem is that serial mail-in prescriptions reflecting changes in medications and/or dose changes can lead to confusion as to your medications.