And who might you be to be authorizing refills?

We’ve got this one doctor’s office that refuses to accept prescription fax refill requests. This means we have to actually pick up the phone and call — but most of the time the phone is busy, so it takes 3 or 4 tries to actually get through. This is annoying, but not the end of the world — we fill a moderate number of prescriptions for him, but most of them seem to be antibiotics and such, with no refills.

What is disconcerting is that when we do get through to the office, a receptionist answers the phone, looks up the file while you wait, reads the prescription in question back to you, and then invariably authorizes it with two more refills. Every single time. I have no idea who this person is or what their qualifications are, but it makes me uncomfortable. Yeah, I have the refill “authorization” within 90 seconds which is nice and convenient… But who’s doing the authorizing? Is she qualified to make the decision? Is the doctor being notified? Are the charts being updated? Who is doing the monitoring? When was Mr Smith last seen in the office?

Am I going to get a phonecall later asking me how the patient is taking the medication?

Call me old-fashioned, but I prefer the black box method of requesting a refill, where a request goes out electronically, via fax, or by leaving a voicemail, and then comes back some time later either authorized or denied. This delay lets me think that the prescriber is actually, you know, looking at the patient’s chart to see what’s going on before making a decision.

I like my comfortable delusion. Even if it is a fantasy and the med in question is “just” glyburide.

3 thoughts on “And who might you be to be authorizing refills?

  1. 1. have read your posts regarding prescription refills
    2. there are truly legitimate concerns about this system
    3. have u considered raising your concerns to your parent retail pharmaceutical industry?
    4. i do not know how this system of “convenience” and “courtesy” came about and evolved; but these slogans are generic to the retail industry looking to generate business from more customers who would find refilling prescriptions by way of the pharmacy, rather than the doctors clinic convenient
    5. convenient, illness, disease could hardly be on a process together
    6. if you are truly looking for a “black box method” to prescription refills, demand a classically legitimate prescription borne out of a patient’s visit with the doctor
    7. #6 can start with retail pharmacies stopping to offer “electronic/automated refills” advertised especially by big chains; this is not much different from DTC advertising, which also do not translate to rational patient care
    8. what do you think about voicing your concerns to your pharmacy headquarters in the northeast?
    thanks.

  2. This method of prescription refill authorization hasn’t changed in more than 30 years. It was going on when I started in community pharmacy in 1978, and all of us–pharmacists, physicians, patients, boards of pharmacy–are complicit in keeping it in place. I can see from these blogs that it is universal in time and space in these United States. But I have never liked the idea that unqualified people are authorizing these refills, and I want them to share in our accountability by being licensed. Here we are, getting ourselves tagged on pharmacy board Web sites and newsletters for dispensing errors and unauthorized refills, and these people are successfully flying under the radar by being able to ride it out, as it were,in the physician’s underwear, a kind of legal penumbral zone. Time for that to end! Our technicians have to be licensed. Why not the “authorized physicians’ agent,” too? They are as much a part of the drug review process as any of us, and they simply cannot be allowed to continue doing what they do without recourse. Really—the doctor isn’t really “there” at the moment of contact. Who are they kidding? They are practicing medicine without a license. It is time that they practice a new profession, that of “physician agency.” Let them enjoy their place in the audit trail!

  3. Paul, I agree. I saw your comments on Jim’s recent blog entry, and I agree with you by and large.

    In terms of liability and whatnot, it’s almost senseless (from a legal and practical PoV) to go after these people if it turns out that they are responsible for a mistake. They have no assets. I suspect this is why they get a free ride “in the physician’s underwear.”

    I wish it wasn’t so, though. :(

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