Having problems getting prescriptions filled? Hofford: Are you having problems getting prescriptions filled?

If you are having problems getting your medication filled or refilled in a timely fashion, you are not alone. As a physician, I am aware that this is a complex issue. Last week the Federal Drug Administration noted 105 medications were in short supply or not available.

Insurance plans are requiring more prior authorizations from physicians before the medication can be filled or refilled, resulting in delays. Some of these prior authorizations are not necessary, resulting in lost time that could be devoted to patient care. Recently a major insurer required a prior authorization for an inexpensive diabetic medication that can be purchased for $4 at a major pharmacy.

Physicians are encouraged or required to fill or refill medications through electronic medical records. Occasionally a generic medication prescribed electronically comes across at the pharmacy as the brand name drug in their software system resulting in an unnecessary prior authorization request. I have noticed, at times, the pharmacy database may not be current with health insurance databases on what is covered.

Some large chain pharmacies are not able to keep their physician location databases up to date. This results in refill requests sent to the wrong office. These errant requests may take up several hours of staff time each week. This creates a delay for patients in obtaining their medication when needed.

When prescribing a new medication for a patient, it is not guaranteed that the medication is covered. There are over 1,000 health insurance formularies. Electronic medical record systems cannot keep up with these diverse plans. Trying to find a particular insurance plan formulary on a health insurance website is challenging since each website is designed differently. Health insurance plans are required by Federal legislation to update the verify that their physician database is correct every three months. Large chain pharmacies should be required to do the same.

With the advent of the COVID-19 pandemic, many local pharmacies are understaffed, and the staff are overworked since they are providing COVID vaccinations along with filling prescriptions as well as offering other vaccinations. My experience is that it is taking up to five days to obtain a refill. Several local urgent care offices are now stocking antibiotics for patients with infections. Waiting five days to fill an antibiotic prescription is simply unacceptable.

So how do we fix this? I have several suggestions. New hiring avenues should be explored regarding full-time and part-time pharmacy staff. Removing some of the vaccination burden from pharmacies can be helpful. Our local health department director, Dr. Cynthia Morrow, and her staff and other local health care workers are helping in this regard.

At my request the Virginia Department of Medical Assistance, which oversees the Virginia Medicaid managed care insurance plans, implemented a common medication formulary for all six Medicaid plans. This has made it easier to treat Virginia Medicaid patients. The Medicaid medication formulary is easily found and does not change frequently. I would encourage or require other insurance plans to follow suit.

Next, the large chain pharmacies should work with the electronic medical record software vendors to ensure that prescriptions arrive at the pharmacy exactly as the physician has prescribed.

Fixing the drug shortages is a national issue since many of these medications are dependent upon suppliers from outside the United States. Producing or manufacturing these medications here is a viable option but will require time and money to implement.

The commonwealth of Virginia may want to explore the feasibility of allowing physician offices to dispense medications to avoid delay in patient care. Changes in regulations will be necessary.

As a patient there are things you can do to help. Physicians, pharmacists, and associated staff are stressed and are catching anger and frustration from patients. Please understand that they are working as efficiently as they can during these trying days. Keeping your emotions in check is essential. If you need a refill, request your medication a week or more before it due to run out.

Dr. Roger Hofford is an associate professor of family medicine at Virginia Tech Carilion Medical School who also teaches at Virginia Commonwealth University and Virginia College of Osteopathic Medicine. He is retired from Carilion Clinic.