Beyond that systemic problem that adds delay, actually dispensing the prescription is not the rate limiting step. When you get a prescription there’s a whole list of things you need to do before it can be dispensed. In no particular order:
Select the right drug which seems easy but the prescriber may have used an old brand name, or misspelled it, or put in something that doesn’t exist.
Calculate days supply (easy for pills, not so much for insulin, creams, eye drops, etc.)
Find the correct doctor in the system
Find the right patient’s profile and see if they really fill at your store
Transcribe the directions in a way that makes sense in less than ~200 characters to fit on the bottle.
Check to see if the patient already has another prescription on file they are in the middle of the refills for so you don’t have two active prescriptions.
Check to see the prescription has all the required information on it to be filled based on state requirements
Send the finalized prescription to the patient’s insurance which inevitably is rejected because of some minor issue with any of the above, or it is expired, or requires prior authorization, or they changed their name, or it is too soon, or it’s not the proper moon phase.
Actually fill the prescription which requires finding it on the shelf which is a mess because you fill ~500 prescriptions a day
Scan the bottle to make sure it’s the same as what you billed the insurance, but if you picked the wrong generic brand on the first step you get to start over.
Clean the counting tray
Count the pills
Get the right vial and label everything with the stickers, and if you need more you need to print more out but someone else has a 50 page print job ahead of you and it’s out of labels
Answer the phone
Answer the drive through
Answer the patient at consultation
Answer the patient at the cash register
Send it to the pharmacist for review which is a huge process on it’s own which requires looking for interactions, appropriate dosage, correct drug for the disease indication, and simply reviewing you got everything transcribed correctly which if it isn’t you get to start all over. Plus there are 50-100 prescriptions already waiting for review.
Process a vaccination patient
Add water to a reconstitutable (powder) medication
If Poseidon wills it, the prescription is approved and then you get to bag it, then put it in the right spot in the bins so it can be found.
If it’s a controlled substance you need the pharmacist to do about 50% of the steps above and access the safe which is a whole process. In the meantime they are on the phone with a doctor or some insurance trying to get something clarified or approved. Or compounding someone’s diaper cream. Or doing vaccinations. Or counseling someone on their antibiotic. Some drugs have mandatory monitoring programs you have to enter information from the doctor before they can be dispensed. Some drugs require a dosage syringe, or intramuscular syringes, or needle tips.
Wow, that is a lot more manual work than I expected. You have to rewrite the directions too? I imagined the prescribing doctor would do that, then all you have to do is look up the order on the computer and print out the label.
Thank you for the explanation, the whole process seems like it could be made more efficient.
Last prescription I got was antibiotics and steroids for an ear infection. The doctor indeed did give me dosage and schedule. Then the pharmacy also gave me instructions, and they were different. Seeing how each Doctor hopefully keeps up with their field and most likely can’t really with others, I’d say the pharmacy instructions are usually safer unless the patient has specific circumstances only the prescribing doctor is aware of.
Sometimes the doctor will write something in latin abbreviations so you have to translate that and write it out in plain text but you typically want to make sure the entire directions can fit on a single label. If you just say “see attached directions” then you may not get paid for the prescription if their insurance audits it they will take back any payment they gave to the pharmacy because you dispensed incorrectly. They may also just write something unhelpful like, “as directed in discharge paperwork” or “to be dosed by pharmacy” or something really long that can’t easily fit.
That said it’s been several years since i have been there so there may have been more enhancements.
I have worked in a CVS so I can answer this first hand. The main reason is every CVS is critically understaffed to the point of danger to patients.
Beyond that systemic problem that adds delay, actually dispensing the prescription is not the rate limiting step. When you get a prescription there’s a whole list of things you need to do before it can be dispensed. In no particular order:
If it’s a controlled substance you need the pharmacist to do about 50% of the steps above and access the safe which is a whole process. In the meantime they are on the phone with a doctor or some insurance trying to get something clarified or approved. Or compounding someone’s diaper cream. Or doing vaccinations. Or counseling someone on their antibiotic. Some drugs have mandatory monitoring programs you have to enter information from the doctor before they can be dispensed. Some drugs require a dosage syringe, or intramuscular syringes, or needle tips.
Suffice it to to say it is an involved process.
Wow, that is a lot more manual work than I expected. You have to rewrite the directions too? I imagined the prescribing doctor would do that, then all you have to do is look up the order on the computer and print out the label.
Thank you for the explanation, the whole process seems like it could be made more efficient.
Last prescription I got was antibiotics and steroids for an ear infection. The doctor indeed did give me dosage and schedule. Then the pharmacy also gave me instructions, and they were different. Seeing how each Doctor hopefully keeps up with their field and most likely can’t really with others, I’d say the pharmacy instructions are usually safer unless the patient has specific circumstances only the prescribing doctor is aware of.
Sometimes the doctor will write something in latin abbreviations so you have to translate that and write it out in plain text but you typically want to make sure the entire directions can fit on a single label. If you just say “see attached directions” then you may not get paid for the prescription if their insurance audits it they will take back any payment they gave to the pharmacy because you dispensed incorrectly. They may also just write something unhelpful like, “as directed in discharge paperwork” or “to be dosed by pharmacy” or something really long that can’t easily fit.
That said it’s been several years since i have been there so there may have been more enhancements.