Why Can't I Fill My Prescription?

Posted by Frank Pallaria, RPh on Jun 14, 2018 4:29:54 PM

Man Waiting with Cast

Filling your workers’ comp prescriptions at a local retail pharmacy can be a hassle. Workers’ comp, which is a different type of insurance than your personal health plan, requires a few extra steps that retail pharmacies may not be equipped to handle.

Drug Formularies

Take for example prescribed medications that are considered “N drugs”, or drugs that fall outside of a drug formulary. If you live in a state that has a workers’ comp drug formulary, you may already know how difficult it is to get your medications locally. If the medication your doctor prescribes is on a list of unapproved medications, the retail pharmacy will likely return the prescription to you or ask that you pay out of pocket. This is because the medication is not authorized and might not be paid by your insurance carrier.

With IWP, we work with your doctor and your insurance carrier to get you the medication your doctor prescribed or a suitable alternative – all at no cost to you. Unfortunately, retail pharmacies just don’t have the time to handle the back and forth to make sure you have the proper care needed, but we do.

Opioid Crisis

With the nation in a deep battle over the opioid crisis, you may have seen a retail pharmacist turn away a prescription that would require them to fill an opioid. Pharmacists do have the right to refuse filling your prescription, because of a company policy or at their own discretion. If the pharmacist feels that the drug could be used for illegal purposes or addiction, they do have the right to refuse the fill.

Because we specialize in workers’ comp and the complex needs of injured workers, we understand sometimes controlled substances are a necessary part of your treatment plan. We proactively work with your doctor to ensure the medications you are taking are not high risk combinations, like the holy trinity. We also track and report to the prescription drug monitoring program (PDMP) daily to help prevent abuse and combat diversion. The extra steps taken by our pharmacist are some that retail pharmacists just don’t have the time for.

Refill Too Soon

Another reason why a prescription may be denied include a refill too soon, which is one of the more common reasons seen. The next fill date is determined by the last fill date, regardless of when the prescription was written. Even if the insurance carrier allows the prescription to be filled early, pharmacists are bound to ensure the health and wellness of patients and refilling a medication too soon can have many negative effects.

This may also be the case if your doctor has ordered you to increase your dosage without writing a new prescription. Although your doctor has changed the order, that may not always be communicated to the pharmacy. If this is the case, our pharmacists will reach out to your doctor and request a new prescription with the updated instructions all to make sure you have the medications you need.

Related: Differences between over-the-counter and prescription

Other reasons why a prescription might be denied include drug shortages or inventory issues, prescription expiration, or the pharmacy may not carry the drug. Large chain pharmacies have even begun taking their own stance on the opioid crisis by implementing restrictions on medications.

Injured Workers Pharmacy has an entire team in place to make sure you get the medications you need. Retail pharmacies just don’t have the time or resources to help injured workers properly. If you have experienced any of the denials above, we may be able to help you. Simply call us at 888-321-7945 and speak with a pharmacist like me or one of our trusted Customer Care Associates.

Topics: Clinical, Workers' Compensation