PIEDMONT ACCESS TO HEALTH SERVICES, INC.

Transcription

1 Policy Number: SUBJECT: Filling Prescriptions PIEDMONT ACCESS TO HEALTH SERVICES, INC. EFFECTIVE DATE: 07/13/2012 REVIEWED/REVISED: 10/24/2013 POLICY: PATHS Community Pharmacy will comply with all regulations, including those mandated by the Commonwealth of Virginia, Department of Health Professionals, as they relate to the process involved in filling prescriptions. New Prescriptions RX Intake Procedure: 1. Ensure the accuracy of all patient demographics and enter them into PATHS pharmacy management system (QS/1). This includes: A. Patient Name; B. Date of Birth; C. Address; D. Phone Number; and E. Allergies. 2. Enter the above information under appropriate patient. 3. Scan written prescription and place in appropriate basket for Data Entry. Data Entry Procedure: 1. Verify whether prescription is to be filled with 340-b or Wholesale stock. See page After verifying, pull appropriate medication from appropriate stock. A. Search patient profile verifying no exact active script exists. If unsure, check with Rph on duty. 3. Enter Rx Data A. Patient Name B. Prescribers Name C. Enter NDC# of Medication prescribed: Choose correct stock, 340-b to left of medication name is designated with *, WholeSale to left of medication name D. Date Page 1 of 6

2 E. Signature of provider F. Authorized Amount G. Refills H. Day Supply I. Third Party (cash, insurance, MEDAssist) Any insurance card not seen in price plan may be entered into the QS1 system. See page 5. J. Rx Origin K. Finish L. Save M. Fill Prior to printing label always double check every aspect of the prescription (Refill and New) Information should be exact. Any changes made on written scanned RX (provider, Rph) must be rescanned. This is possible during any phase of the filling process. 4. Measure / Count and package the medication. 5. Read label to ensure accuracy and apply to medication container. Third Party Prescriptions Procedure: A. Adding new Insurance Card 1. Under Third Party Price Plans Parameter Information Transmission Options a. Make sure the box next to Print is $ Paid is < Acquisition Cost: is Unchecked. B. Electronic Claims Log 2. No label and the claim is marked Paid : a. Check for lower-case a beside the claim line in the log. If a is present, the total adjudication and copayment are less than the acquisition cost of the prescription. b. If the total amount paid is less than acquisition by $19.99 or less, continue with filling the prescription. c. If the total amount paid is less than acquisition by $20.00 or more, reverse the claim and notify pharmacist. The pharmacist on duty will review the issue and either contact the payer directly, or seek support from PATHS administration. In the event that it is decided that the pharmacy cannot fill the prescription because of the loss, the claim should be reversed and voided from QS/1. C. If the claim is marked rejected : 1. Open the claim and review the information provided in the Messages, Free Text Message(s) from Third Party and view DUR. 2. Address issues accordingly. Once addressed, select correction, make changes and resubmit the claim. Repeat the steps outlined above. If there is no way to correct the issue (i.e., the refill is being requested too soon according to the prescription), notify the patient and return the medication pulled to inventory. Page 2 of 6

3 MEDICATION SHORTAGES 1. When a prescription, new or refill, cannot be completed due to any of the following: Inadequate amount available on shelf Manufacturer cannot supply Warehouse shortage Warehouse mispick Error in ordering REVERSE THE FILL and notify patient explaining situation and giving the expected date of arrival. NO EXCEPTIONS. REFILL RX Patient is unable to wait for the medication to arrive: Offer to transfer the prescription to the Pharmacy of their choice. If patient opts to wait for medication. Give patient a reasonable time that the prescription will be ready for them to pick up. Gather any important info that patient states (please call patient etc.) and enter this info along with RX# and estimated date and time of pick up into Tickler. NEW RX If out of stock inform patient and offer to order giving date of expected arrival. If patient needs to fill today RETURN WRITTEN RX to patient if E-SCRIBED offer to TRANSFER to pharmacy of choice. Page 3 of 6

4 REGULATIONS FOR USING MEDICATIONS FROM 340-b This Pharmacy has 2 drug inventories: Wholesale and 340-b stock. These two inventories are physically kept separate from each other in the pharmacy. Pharmacy employees are required to fully understand all circumstances surrounding the use of 340-b medication for prescription. Requirements: 1. Prescription must be written by a PATHS provider located at any of the PATHS locations (Martinsville, Chatham, Danville, Boydton) AND 2. Patient has no prescription coverage, cash or has prescription coverage that is not listed below: Name of Insurance BIN # PCN # GROUP Fee for Service DRVAPROD (BLANK) AMERIGROUP Adv Rx4294 ANTHEM A4 WLAA COVENTRY HEALTHCARE OF VA ADV CVTYMCD ENVISIONS 9893 PARTD V7HA MAGESTACARE A4 VM3A OPTIMA OHPMCAID (BLANK) OPTIMAHEALTH OHPCOMM SFC VAPREMIER ROIRX V7HA These insurance codes are loaded in QS1 and are marked with? meaning one needs to look at patients insurance information to verity NOT included in the above list. Page 4 of 6

5 QS1 has a program called the price plan wizard. INSURANCE CARD ENTRY A Price Plan is a term that QS1 refers to as a Third Party Insurance or Coupon. To add a new card that is not located in the list of price plans, simply hit the New button and the Wizard walks you through each and every step. ***Required step that is not included in the Wizard Setup. 1. After setup is complete: a. Store Control tab----pricing Options----Price Plans----search for new price plan just entered---- double click----choose Parameter Information on left hand side----under Transmission Heading make sure the statement Print if $ Paid < Acquisition Cost is unchecked. See below for example. Page 5 of 6

6 SIGNATURES: Pharmacy Director Chief Operating Officer Chief Executive Officer / / Date / / Date / / Date Page 6 of 6