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PHARMACY POST (CONT.)
• Pharmacy tech
speaks to customers in most pharmacies
distributes medication
enters data from customers about their insurance, processes co-pay cards and savings. Troubleshoots rejections and prior authorizations
3. How do I improve interactions with our pharmacies and their staff? Pre-call plan using:
TEXAS STATE BOARD OF PHARMACY website to look up pharmacists and Pharmacy Techs.
https://www.pharmacy.texas.gov/dbsearch/default.asp
Using this site prior to the call can help us identify key players prior to walking in,
Rx4Success Updates
Now shows volume and the brand of Novo products each pharmacy is filling.
4. Are we mindful about acknowledging the happenings in the pharmacy when we approach them?
Do they close for lunch and are they open for meeting then?
Do they accept co-pay cards to leave and process vouchers?
Are there any frequent offenders - offices or physicians that send prescriptions with errors resulting in call backs?
Opportunity: work with the offices to make sure their EMR and staff are sending accurate information to improve ease of filling.
5. What do they find most challenging and/or rewarding in their role?
6. What wholesaler do they purchase from? And who is the backup wholesaler? 7. Are there any resources that they need for your staff or patients?
Terms to keep in mind:
Lookbacks - automation/look-backs for a few of our larger PBMs. For more specifics, and more payers, we can reach out to the respective RAM.
ESI - look back for 1 OAD (may or not be metformin) Cigna - look back for 1 OAD (metformin included)
Prime – look back for Type 2 diagnosis, metformin or insuli Navitus – look back for Type 2 diagnosis
Aetna – step edit through metformin, SU or TZD for all GLPs
If the look backs are not present, then various PAs and/or Step Edits take place. These are different for each payer.