It's 7:30 at night, you've had to leave work early to go to the doctor's office or emergency room, where you've had to wait for 3 hours before getting to see a doctor. And now you enter the pharmacy to get a prescription order filled. As you hand your prescription order off to the pharmacy staff, you begin to wonder just how long it is going to take before you can get home to the family.

Some 20 minutes later, you walk out the door, prescription in hand, now confident that you'll be feeling better in just a few days. What has just taken place? You may not have realized just what the pharmacist has been doing for you in that time span. In just a 20-minute time period, the pharmacist has been not only been packaging your prescription, but has been systematically recording and analyzing your prescription order.

Your Medication Advocate "Behind the Counter"

As you first enter the pharmacy and then drop your prescription order off at the counter, you may be asked to answer several questions:

What is the correct spelling of your name? - Why might you be asked your correct spelling of your name? Well, unless you have an established relationship with the pharmacist and the pharmacy technicians at your regular pharmacy, there may be a question as to the spelling of your name. It is important to your pharmacist that all aspects of your medication file are accurate and up to date, especially something as central as the spelling of your name. Unless some form of your name is presented to the pharmacy staff (for example, an insurance card), it is difficult to be certain.

What is your date of birth or telephone number? - Even if you get all of your prescription orders filled at one pharmacy, you may find yourself being asked this question every time. Your date of birth or telephone number is in a sense, a second form of identification. For pharmacies that serve many customers, there is always more than one "John Smith" in the computerized pharmacy records system. If the pharmacist sees that it is John Smith, at phone number 555-1234, then he or she can be certain that your medication history can be checked against your new prescription order that is being filled.

Would you like a generic version of your drug product? - Doctors have the option when either writing on a prescription blank or telephoning in to your pharmacy to use either a drug's brand name (name given to the product by the drug's manufacturer) or it's generic name (the non-proprietary name or non-brand name) when ordering medication for you. To further complicate the procedure, all states differ on their laws governing the pharmacist's substitution of a brand name for a government-approved generic product. The doctor can either approve a pharmacist's substitution for an equivalent generic product or deny the substitution by specifying "substitution allowed" on certain areas of the written prescription (again laws differ state to state). It is always best for your doctor, unless the physician is sure otherwise, to allow substitution. The pharmacist then can help you select the best generic or brand name that is the most cost effective for the drug your physician has prescribed.

Would you prefer a child-resistant cap, or an "easy-open" cap? - The choice of a "child-resistant" or "easy-open" cap is something that the pharmacy staff asks you for your convenience. Subject to the Poison Prevention Packaging Act, passed by Congress in 1970, it is the responsibility of your pharmacist to make sure your prescription is dispensed in the appropriate container. With only a few exceptions, the pharmacist must dispense the prescription with a child-resistant closure, unless the patient or prescriber specifies otherwise.

"Behind the Scenes" With Your Pharmacist

Why may it take 20 minutes or more for your pharmacist to fill your prescription order? To undrstand that, you should be aware of the steps that must be accomplished to make sure your prescription medication is right for you:

Checking the written prescription order - Often times, there are some basic clarifications to be made in your written prescription order. Unfortunately, prescribers occasionally omit important iformation or write illegibly, making it difficult for the pharmacist to identify specific instructions for the use of your medication. In these instances, you may find that your pharmacist needs to speak with your prescriber to clarify the meaning of the written order.

Entering your information into the computer - The pharmacy staff then begins to enter your prescription information into the computer system. This ensures that a complete record of your medication history is at the fingertips of not just the pharmacist, but also your physician. You may never know when an emergency situation may arise and your physician will need to know exactly what medication you have taken and how you take it. To make sure that your medication record is complete, you should always patronize the same pharmacy, and you should inform the pharmacist of any drug products -- prescription and nonprescription -- that you might have obtained from another source. >Checking your prescription history -After the information has been entered into the computer system, the pharmacist proceeds by checking your prescription history. They look for therapeutic duplication. Therapeutic duplication is the simultaneous use of two or more medications that serve the same purpose. For example, if you have been prescribed two similar antibiotics by different doctors on two separate occasions, it is cost-beneficial and in some instances imperative for your health that you not be taking two medications for the same thing. A call may be required to one or more or your prescribers to see that you are not wasting your money or taking excess amounts of medication.

Guarding against drug interactions - Pharmacists also look for interactions. Interactions are the combined effects of two causes that differ from the sum of the two combined causes. Interactions not only occur between prescription drugs, but also over-the-counter medications, foods and beverages, and other diseases you may have. Good examples of interactions include those between some antibiotics and over-the-counter products for indigestion. Several antibiotics can also interact with dairy products, while other prescription medicines should not be taken with alcohol. An example of a drug-disease interaction involves certain decongestants for stuffy noses and patients with high blood pressure.

Checking dosage and duration of therapy - Pharmacists continue to check the correctness of your prescription by verifying the dosage and duration of the medicine's use. All medications have standard recommendations for their use. When your prescriber varies from standard dosages and duration, or prescribes a drug that is not commonly used to treat your condition, the pharmacist may need more information to be sure your drug therapy is best for you.

Most often, you, the patient, are the best source for the answers that the pharmacist needs. The pharmacist most often judges the appropriateness of your drug's dosage or strength based upon your age and/or relative weight. The pharmacist judges the appropriateness of your duration of therapy by judging the quantity of tablets or capsules prescribed to you (along with the number of renewals authorized) against the type of conditions for which the drug is prescribed. Often times though, the pharmacist will need to call your prescriber to clarify dosages and strengths of the medication you will be taking. It is in these situations that your pharmacist may make recommendations to your prescriber regarding the dosage or duration, or even for reasons of cost or effectiveness, the type of drug prescribed for you.

Checking against allergies - Pharmacists also verify, by reviewing your medication records, each and every time that you have your prescription orders filled whether or not you are allergic to your medication. Pharmacists save the health care system billions of dollars every year by preventing drug allergies (it is estimated that adverse drug events cost the U.S. $76 billion annually!). Severe drug allergies can result in hospitalization or at least unnecessary visits to your doctor.

Working with your doctor for you - Pharmacists are taught not only to recognize drug interactions and allergies, but also to decide and recommend the best alternatives to the prescriber when these do occur. The best patient outcomes occur when your pharmacist and your physician collaborate to decide upon the plan for you. When the largest amount of information is brought together in one step that occurs by the exchange of information between the prescriber and the pharmacist, you can be sure that the best decision is being reached. This is exactly the same approach that you take as a patient when you get a second opinion from another physician.

Working with your insurer - For many Americans, using an insurance card has become a routine when getting health care. Employers and state benefits agencies are providing health insurance benefits for prescription drugs to their employees and citizens unlike ever before. The pharmacist has had to change to meet this growing need. Your insurance company requires that the pharmacist file a claim containing information such as your social security numbers, your date of birth, an identification number for your physician, the name and strength of your drug, the quantity dispensed, and the number of days that your supply will last. Some companies ask for more information than, this -- other require less. Some insurance companies accept electronically filed claims, while others may accept claims only on specific forms submitted via the mail. Insurance companies have no standardized way to submit these claims, often making it difficult and time consuming to submit your claim to your insurance company. Hundreds of insurance companies now accept pharmacy claims. It is up to your pharmacist to know what information and in what way the insurance company requires the information to be sent to them. This may be especially time consuming if you have never used your insurance card before at the pharmacy you are visiting.

Some companies can even decline to pay for your insurance claim, even when both the physician and the pharmacist believe the medicine prescribed is the best one for you. Because of all of these variables, some pharmacies cannot file your claims for you. Often, it is because your insurance company has already decided for you which pharmacies that you can use with your insurance card. By state and federal law, all pharmacies have the same standards of practice. All pharmacists have the same standards of practice by the licensure in each state. However, your insurance company may limit where you can have your prescription orders filled so that they may reduce the costs of the claims that they pay, even if the insurance company must sacrifice the quality of your care with both the pharmacist or the physician.

Double-checking the prescription - The pharmacist then reads the label that has been placed on your prescription. The written directions have been checked as the information was entered into the computer record system and are now rechecked against the same written order. The contents of the bottle or package are checked against the manufacturer's bottle or package to ensure that what was prescribed is the same as what was placed in your bottle. Warning labels are now placed on your prescription bottle to warn you of side-effects, interactions, or other important messages.

Counseling you about your medicine - The most important thing about getting a prescription filled to this point has yet to be discussed. This is the actual time spent between your pharmacist and you. Just before you pick up your prescription and are near the end of your trip to the pharmacy, your pharmacist hopefully takes a few moments to discuss with you your medication. Whether your pharmacist simply points out a few important tidbits about your drug therapy, or takes you aside to detail the entire story regarding your prescription, this sharing of information is the key to assuring a successful outcome of your trip to the doctor. By making sure you understand how to take your medicine, what kind of results you should have and when you can expect them, and what to look for as you continue to take your medicine, the chances of you getting better increases dramatically.

Created by the American Pharmacists Association