Do Doctors Get Paid For Writing Prescriptions

How to Avoid 10 Common Roadblocks at the Pharmacy: A Doctor's Advice

December 5, 2019

Primary care doctors regularly field calls after hours from pharmacies and patients who run into trouble getting new or refill prescriptions. It's a frequent source of lost time and frustration for everyone involved. Patients often tell me they hear the dreaded voicemail from the pharmacy that there is a "delay" on their prescription. After 20 years working as a primary care doctor, I've heard the same issues about prescriptions over and over and have laid out some solutions for you.

1) My insurance won't cover my prescription

If this is a new or refill generic medication for you, check the cash pay price at GoodRx right off the bat. This will allow you to pay for it without having to embark on a prior authorization process with your doctor.

Same goes for a new prescription of a one-time thing like seasick patches, antibiotics, or a sleep medication. Just ask the pharmacist if you can pay cash for it so there's no delay.

If it's a new prescription that will be ongoing (for example, overactive bladder medication, high blood pressure meds, or diabetes meds) contact your doctor right away to get the prior authorization.

2) My insurance said it's too soon to fill my prescription

I get this call all the time, and patients interpret this as a law or something written in stone. It's not (unless we're talking about controlled substances, like opioids). Your insurance company won't pay for a fill this soon, but with a doctor's prescription you absolutely can get it filled. This may happen if you've changed from one medication to another (like a new form of birth control or dosage of blood pressure meds) and you've filled a prescription for the previous medication in the past 30 days.

Again, just ask to pay cash for it after you've checked GoodRx.

3) My pharmacy says I can't get a 90-day fill

If the doctor has written you a 90-day prescription, you can absolutely get it filled. Again, it's just that some insurance companies won't pay for 90 days at a time. If you've checked with your doctor and they've written a prescription for 90 days at a time with refills, tell the pharmacist you'll pay cash for it (if it's affordable) and not use your insurance.

4) The pharmacist wouldn't fill my prescription because there's a drug interaction

This warning is triggered most often in folks taking warfarin (Coumadin) or those taking 2 medications known to affect the electrical activity of the heart. These risks are minimal, and if your doctor prescribed this medication and is aware of the interactions, the prescription should be filled.

If you can't get an important prescription, don't leave the pharmacy without it. Instead, ask the pharmacist to call your doctor's office or call the doctor's "on-call" service to get approval.

This one is a frequent offender over the weekend, especially with antibiotics. On weekends, it's more difficult for pharmacists to reach a doctor's office, so they're more likely to put a hold on the prescription.

5) The pharmacy has that on back order

If this happens and the pharmacy can't order it and get it for you soon, check to see if other nearby pharmacies have it in stock. You don't have to go without it.

6) My medication was discontinued—now what?

The very common blood pressure medication losartan (Cozaar) has been plagued by this. Call the doctor's office or after-hours number so they can prescribe you a different drug before you run out of blood pressure medications.

7) It's a weekend, so the pharmacy can't get approval for my prescription

Patients say this comes as a voicemail from the pharmacy saying there is a "delay" in one of their prescriptions. If you are heading into the weekend without your diabetes, blood pressure, or heart medication, first look at the cash price on GoodRx. Pay cash (if it's reasonable) and skip the delay.

If the cash price is too high, call the doctor's exchange if it's after hours or the weekend (trust me, I get that call all the time). Your doctor can approve a similar drug in the class or try and accelerate approval. Don't go a week without it.

8) I'm leaving town for the summer—can I get a 90-day supply?

Yes, you can. If you are leaving for an extended period of time and have a medication you've been on for a while (like birth control, blood pressure, or an antidepressant), ask your doctor to approve 3 to 6 months of your medications.

Again, you may have to pay cash for some of it (these are roadblocks your insurance company has put on, not a "law") but you absolutely can get enough of your medications if your doctor approves it.

9) I went to get my flu shot, and they asked me about all my other vaccines

I appreciate that pharmacies provide vaccinations, but patients have occasionally been told they need vaccines when they don't. An annual flu shot is great, but please ask your primary care doctor if you are due for a Prevnar or Pneumovax (both pneumonia vaccines), Shingrix (shingles), or Tdap (tetanus, diphtheria, and whooping cough) before you get one. I have many folks who've gotten duplicates.

10) I lost my prescription medications—what can I do?

If you've left a routine medication somewhere or lost it and the pharmacy tells you they can't fill it, yes they can. Ask your doctor for a refill. You may have to pay cash for it, but this is an easy fix.

This advice does not apply to controlled substances, which will be trickier and often require a visit with your doctor. Most doctors won't refill a controlled substance for a lost prescription without seeing you first.

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Hope these help.

Dr O.

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