50 Things That Could Go Wrong When Filling a Prescription

The prescription filling process is filled with pitfalls and potential problems.

Patients and prescribers often don’t understand why it takes so long to fill a prescription. The whole process seems so simple: count the pills, label the bottle. What’s left to do?

Even when things go swimmingly, there are still a ton of additional things the pharmacy and pharmacist need to do in order to make sure the correct patient is getting the correct medication and is properly educated on how to use it. There are many steps, laws, challenges, and distractions when filling a prescription.

In the ordinary course of filling a normal prescription, there are literally hundreds of possible pitfalls along the way. If you added up all the things that could go wrong throughout our entire health care system, they probably still wouldn’t outnumber the things that could go wrong when filling the average prescription at a local retail pharmacy.

The 50 issues included in this list are neither fictional nor exaggerated. They occur every single day in every single pharmacy across the country. In my 20+ years of work at a community pharmacy, I’ve seen each and every one of these situations. In fact, a very small minority of prescriptions actually make it from start to finish without encountering one of these issues.

By the way, I’m not excusing any mistake or pandering for sympathy. I’m simply aiming to shed light on the challenges faced by pharmacy staff and raise awareness of the importance of vigilance throughout the prescription filling process.

Patient-Related Issues:

1. Patient doesn’t have their insurance card.

2. Patient has the wrong insurance card.

3. Patient has new insurance but never received a card, lost it, or forgot to bring it.

4. Party dropping off the prescription doesn’t know anything about the patient (eg, DOB, address, allergies).

5. Patient lost the prescription on the way to the pharmacy.

6. Prescription needs to be transferred, but the other pharmacy is closed.

7. Prescription needs to be transferred, but don’t have any refills.

8. Prescription can’t be filled because it was just filled here recently.

9. Prescription can’t be filled because it was filled elsewhere recently.

10. Prescription can’t be filled because a very similar drug was just filled here or elsewhere.

11. Prescription is fake.

12. Patient doesn’t have appropriate identification needed to pick up the prescription.

13. Patient can’t pay the co-pay.

Insurance-Related Issues:

14. Patient’s insurance has been terminated.

15. Information on the insurance card is illegible.

16. Patient’s insurance doesn’t cover them out of state.

17. Patient’s insurance limits them to certain pharmacies.

18. Prescription is for an OTC product not covered by the insurance.

19. Prescription is for durable medical equipment and can’t be filled at the pharmacy.

20. Prescription requires prior authorization.

21. Prescription quantity exceeds what’s allowable either by law or the insurance.

22. Dosage exceeds what’s allowable by the insurance.

23. Insurance rejects the prescription after deeming it inappropriate for the patient’s age.

24. Insurance rejects the prescription because it prefers a different version of the drug.

25. Insurance rejects the prescription because of perceived clinical issues.

26. Insurance won’t pay for the brand name, but either the patient or prescriber insists on the brand.

27. Two insurances need to be billed, but it isn’t working.

28. Prescription is for a specialty medication that must be filled elsewhere.

29. Prescription is for a maintenance medication that must be filled by mail order.

Pharmacy-Related Issues:

30. Drug isn’t in stock.

31. Drug was supposed to come in, but didn’t.

32. Drug is on backorder.

33. Pharmacy entered the wrong patient into the computer.

34. Pharmacy entered the wrong drug, quantity, dosage, directions, refills, or prescriber into the computer.

35. Pharmacy miscounted the prescription or provided the wrong quantity.

Prescriber-Related Issues:

36. Prescription was never sent to the pharmacy.

37. Prescription was sent to the wrong pharmacy.

38. Prescriber gave the patient a different patient’s prescription.

39. Patient’s name and information is illegible.

40. Drug and directions are illegible.

41. Drug, strength, or dosage form doesn’t exist.

42. Prescription is missing a critical piece of information (eg, drug name, quantity, directions)

43. Number of refills is inappropriate or illegal.

44. Drug isn’t appropriate for the patient due to a drug interaction.

45. Dose is incorrect or inappropriate for the drug and the patient.

46. Patient is allergic to the drug.

47. Prescription can’t be filled as written because it violates one of many hundreds of pharmacy laws.

48. Prescriber isn’t eligible to prescribe the drug.

49. Prescriber didn’t include DEA, NPI, or other relevant identification on the prescription.

50. Prescriber can’t be located to help correct an issue on the prescription.

The average pharmacist or pharmacy technician could easily add another 50 or so items to this list without batting an eye. But, hopefully this list serves as a good reminder of everything that could (and often does) go wrong. Maybe, just maybe, we can work together to do our part to reduce problems with prescriptions.