So you’ve been diagnosed with pulmonary arterial hypertension and your physician has prescribed a new medication. You are anxious to get started and run to the pharmacy to pick up this very important medication only to be told they can’t give it to you. It is frustrating for patients and providers when there are problems with pharmacies filling new prescriptions. Why does this happen?
There are a few common reasons pharmacies give for delays in filling new medications.
- They never received the order from the doctor’s office: Perhaps the physician called or electronically sent the script to the wrong pharmacy or perhaps the pharmacy lost it in the sea of prescriptions coming in. Either way, notify your doctor’s office immediately letting them know the pharmacy cannot find the order.
- The pharmacy has to order the medication: Pulmonary hypertension is a rare disease and many pharmacies do not keep medications such as Adcirca or Revatio stocked. Check with the pharmacy to see when they will be receiving the medication or if you can go to another location and pick it up. Contact your doctor’s office and ask if samples can be provided until you are able to pick up the medication.
- Medications must be filled by a specialty pharmacy or a mail order pharmacy: Each insurance company is contracted with different pharmacies. Your insurance company may require you to fill “specialty” medications, medications used to treat PAH, at a specialty pharmacy or at a mail order pharmacy. Let your doctor’s office know right away so a new script can be sent to the appropriate pharmacy.
- Waiting on insurance authorization: Because medications to treat pulmonary hypertension are very expensive most insurance companies require that your physician obtain a prior authorization prior to the pharmacy dispensing. The nurse coordinators at your doctor’s office will either call or submit paperwork to your insurance outlining the medication being prescribed, the reason for the medication, and submit supportive documentation such as clinic notes or right heart catheterization reports. The insurance company then considers the request and approves or denies the medication. This can take anywhere from a few minutes to 10 days depending on which company provides your prescription benefits. Often times your doctor will be able to provide samples to you while they are waiting on the approval.
The most important step for the patient to take is to contact the physician’s office immediately. Do not wait for the pharmacy to contact your doctor’s office.