Final Policy and Procedure SubmissionIt is time to synthesize the elements of your Policy and Procedure into a document. Your document should be a 3-4-page paper, written in APA format, which draws up

Inventory Management

Vondra Wesley

Rasmussen College

Author Note

This paper is being submitted on February 27, 2019, for Stanley Sangar’s Pharmacy Technician Capstone course.

Inventory Management

Rejected Insurance Claims -There are various reasons for insurance claims to be rejected and it is very imperative to have these issues correctly adjusted to maintain an accurate inventory count and positive customer service. The Pharmacy Technician must review why the claim was rejected and research a possible solution for the issue: DAW (dispense as written) rejections occur whenever the insurance may not want to pay for a brand medication because of the price. Most insurance companies would rather pay for the generic over the brand version of a drug because the generic is much cheaper. It is required for the prescriber to put on the prescription a DAW code and this will let the insurance company know that this is what he or she has requested for the patient and that it's medically necessary. Example: Insurances refuses to pay for the brand, Technician processes order for generics but gives patient brand medication (Brand is more expensive), the patient will receive a lower price, but the Pharmacy will lose money, and the inventory will not be correct since the order received approval for generics and patient given the brand. In the inventory count, it will show a discrepancy in the actual amount of brand on the shelf compared to what’s on the report. Days’ Supply. Majority of insurance companies only pay for thirty days of medication at a time, and unless the technician or patient calls the insurance company and verifies the reason for more than thirty days, it will not receive approval. The technician must input the correct dispense amount under the approved amount of the insurance company, and any overage must be put in as another form of payment. If improperly done and the patient is given more under the claim, this will cause an inventory shortage. For example: Pharmacy has 200 Lipitor 10mg @ 1.75each tablet in stock. Jane Doe has an on-going prescription for Lipitor 10mg 1 daily, qty 30. Ms. Doe is requesting 90 tablets. The insurance company only approves 30 tablets. The Technician processes the prescription for 30 tablets but gives the patient 90 tablets. The pharmacy inventory will show up as 60 tablets short and $105.00 short, which is a loss to the pharmacy assets as well as a loss if four other patients came in and needed Lipitor 10mg 1 tablet daily qty 30. The Pharmacy would be ten short, therefore also losing a sale. DAW SOLUTION- First the Technician should be familiar with the various DAW codes and their values to be able to resolve the issue. In this context, we see a DAW was sent back to the Pharmacy because there was no specification as to who requested for the prescription to be filled as a brand drug. The Technician should review the prescription and verify whether the healthcare provider requested a brand or the patient. If the Physician requested brand, the DAW code should be entered as DAW 1, if the patient requested DAW 2 and resubmitted. If approved by the insurance, process the claim. If not approved, refer to the Pharmacist to contact the Physician about changing the prescription. DAYS SUPPLY SOLUTION- Review the prescription, making a note of the strength of prescribed medication (determine if it’s one single dose or more), administration orders and how many days is prescribed and perform the proper calculations. Your final answer will be your days’ supply: Lipitor 10mg, one tablet PO daily x 30 days, six refills. Patient requests 90 days’ supply (3 months). Technician inputs the prescription with the request of 90 days’ supply. Insurance company rejects (only will cover 30 days). Consult with Pharmacist about speaking with the insurance company for the patient to get an exception by providing reasoning for a request or speak to the customer concerning contacting their provider about writing a new prescription indicating a 90 days’ supply. After input of the new prescription, submit it to insurance. If approved continue filling the order, if not have the patient consult with their provider about making contact with their insurance company to request an exception. But as with any issue that relates to a patient and their medication, always consult the Pharmacist on the proper way to resolve any problems. Managing the inventory is a critical responsibility for the Technician to maintain at all times to ensure that the Pharmacy is always in stock to provide the proper care of the community, safety, and profit of the pharmacy. Adequate stocking of the inventory will eliminate a stressful issue whereas having a customer come in with a prescription request and can’t receive the medications they may need. Not only is that poor customer service, but can also contribute to the loss of customers and profits. Removing and sending back medications due to expiration dates is another way that provides safety for the patients and some manufacturers will give credit back to the Pharmacy. By following an on hand, ledger will help eliminate overstock. With the new technology available, it helps to prevent shortages and overages by recording what's on hand and what has been dispensed. Some systems are pre-programmed to order whenever a medication reaches a certain level down automatically. Time management and completing each day required tasks is an essential element to be practiced in any work environment and can increase productivity, less stress, additional time to accomplish other tasks. Proper time management ensures an efficient and adequate workflow. When the proper time management skills exist, it creates an atmosphere of a sense of completion and optimum patient care and provides opportunities to assist and learn other areas of the work environment or to lend a helping hand to co-workers or anyone else needing assistance.

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