The Prescription Run-Around

A few weeks ago, I had a cough—seemingly related to allergy-induced post-nasal drip—that lasted about two weeks before I went to my primary care doctor to find out what was wrong, as OTC cough medicines and antihistamines weren't helping. After signing in at around 4:45PM, taking a seat in the waiting room, and taking notice that the staff at the front desk was still using dot-matrix printers and computers with that old black screen and orange-yellow text, I was called back to the exam room at 5:25PM. After my blood pressure was taken, no doubt with the original cuff from when the office was opened in the late ‘80s, the physician who saw me prescribed a prescription cough syrup, Biaxin, and inhaled albuterol (I’d been wheezing a bit). I drove right to my local CVS pharmacy, and dropped off the three paper scripts with the head pharmacist there, at about 6:30PM. He told me they were swamped and that they might be ready by 9:00PM, so I should come back.

So, I drove the 15 minutes home, ate a quick dinner, and drove the 15 minutes back. After waiting what seemed like forever, the pharmacist—now one of only two people still working in the CVS—finally came over to ask what I needed. After looking through the “C” bin at least three times, he walked over to a computer and searched for my information for about 10 minutes. He then proceeded to look through three of four different piles of paper before remembering that he didn’t have the order ready because it was the first time I’d ever filled a prescription at that CVS; he needed my insurance information and address so he could enter me into the system. He told me he’d “try to get these filled by 10:00PM when we close, but I can’t guarantee it. Come back at 10 of and hopefully they’ll be ready.”

Great, just long enough that I wouldn’t want to sit in the store, but not really worth driving home, because I’d need to just turn right around. But I had nothing else to do, so I drove the 15 minutes home, said “Hi” to my wife, blew my nose a few times, and headed back to CVS. Guess what, they weren’t ready, and the store wouldn’t be open until 8:00AM the next morning, the same time that I need to be at least 30 minutes into my hour-plus drive into the office. (Here are the back and forth trips I had to make). I needed to make the decision of either going another day un-medicated or being late for work.

Now, this entire situation could’ve been avoided—and I could’ve enjoyed a good-night’s sleep without having to shuffle my way downstairs to the couch in order to not keep my wife and children awake with my coughing and hacking—had my physician used ePrescribing software to send my prescriptions over to CVS, and had the pharmacist been capable of receiving it; using the demographic information capable of being included in an e-prescription (my name, zip code, birthday), the pharmacist could have accessed an existing database to correctly identify and assign my insurance information—thus possessing all the pertinent information he needed to enter me into the CVS system even before I arrived at 6:30PM. I then could have taken my prescribed medications that night, experienced a good night of sleep, and been on my way to feeling better 12 hours earlier.

Of course my situation—likely just a common cold, although a diagnosis was never provided—wasn’t serious in the grand scheme of illnesses, but what if it had been? What if those 12 hours could’ve been the difference between a relatively pain-free recovery that resulted in no long-term complications and a long recovery, resulting in unnecessary pain and other long-term complications, including those that lead to death? Keep in mind that a diagnosis was never received, so what if 12 hours made the difference in when I reported to my physician that I’d seen no changes in my symptoms, despite taking the prescribed medications, in turn leading to a delay in trying another treatment approach? What if these delays lead to death because the physician was never able to determine the cause of my symptoms? It’s not likely, but it could happen.

And it doesn’t need to. Participation in the NEPSI program is free and available to every physician in the US. Please check it out if you’re not already using an ePrescribing program that allows pharmacists to use the included information to check on insurance coverage and get first-time patients into their system. This knowledge could also help determine, before the patient gets to the pharmacy, what prescriptions are covered under the patient’s insurance, what he or she will pay out of pocket, and what other options are available, saving time and money. You owe it to yourself, and you owe it to your patients.