7 Ways Pharmacists Are Like Social Workers

Most patients understand very little about the amount of social work pharmacists perform on a daily basis.

Yes, community pharmacists fill prescriptions with documented accuracy and educate patients about their clinical conditions. But, as we say in our store, all prescriptions are not created equal.

In addition to our normal community pharmacist role, we’re also tasked with what seems like a never-ending flow of the following social work.

1. Finding the Patient's Prescription Insurance Card

Quite often, patients show up at the pharmacy without their insurance card, or without a clue of what it even looks like.

We find ourselves shuffling through a stack of cards that the patient hands us, searching for something that may look like a prescription insurance card. Alternatively, we ask the patient what pharmacy they’ve used in the past so that we may phone that pharmacy and politely ask if they might help us identify the patient’s insurance.

2. Dealing with Expired Insurance

Most patients believe that they’re covered with some sort of insurance. If patients are bluntly told that their insurance has expired, their response is combative more often than not.

In this situation, it’s best to begin by asking if the patient’s employer recently changed insurance plans. In many cases, patients are still covered but just don’t have the correct card in their wallet.

When patients are adamant about their insurance coverage being active, the conversation seems to go smoothly when we explain that we don't doubt that they’re covered; it's just that something has changed in their insurance and we’re not able to bill for the prescription until we have the new card. The cash option isn’t as painful when the patient understands that there may be some reimbursement in the future when they’ve located their new insurance card.

3. Explaining Insurance

How many times a day do we get asked questions about a medication’s cost? With deductibles, coverage gaps, donut holes, and 4 different tiers of medications, it’s rare to see a standard co-payment on a monthly basis on anything except a simple generic refill.

At this point, it’s critical to remember that the patient in front of us has never heard our explanation of a deductible or coverage gap, even though we’ve been describing this concept to many patients every day. The conversation will go much more smoothly if we take the time to describe the details as if it were our first time ever explaining them to a patient.

4. Coordinating Insurance Authorization

If a patient’s prescription was covered last month but isn’t being paid by insurance this month, we take the time to call the insurance company, work our way through the automated system, and finally get to speak with an individual. After some discussion, the individual transfers us to the prior authorization department.

This new representative helps us understand that the insurance formulary parameters have recently changed, and this medication now requires a clinical review before it will be authorized for payment. We then take the time to explain to the representative that the patient is stable on this medication, has been taking it for more than 4 months now, and took the last available dose this morning.

The representative understands but still needs to have a completed authorization form from the prescriber in order to begin the clinical review. He or she explains that this process may take 5 to 7 business days.

The authorization department agrees to fax a request form to the physician's office in order to get the process started. We now need to work with the patient in order to prevent a lapse in therapy.

This process involves in-depth coordination that may include a purchase of a few days’ supply of medication, samples from the physician's office, or perhaps a different medication. As a community pharmacist, it is our duty to follow through on the care for these patients.

5. Referring Patients to Local Free or Low-Cost Clinics

As a benefit to our community, we take some time to learn about the programs available in our town that offer free and low-cost medical care, such as Rota-Care, hospital-based mobile clinics, and homeless shelters. Patients are incredibly grateful when they realize that they have an option for some sort of limited health care availability.

6. Referring Patients to Specialists

Community pharmacists are on the front line of patient care. We regularly come into contact with individuals who are in need of services such as diabetes education, addiction counseling, or psychotherapy.

We need to have a good understanding of what services are available in our community so we may be ready to refer patients appropriately when the time comes.

7. Helping with Hospital Discharge Planning

We know that hospitals will do whatever it takes to keep a patient from being readmitted after discharge. Discharge planning teams have been developed in most hospitals and include social workers, nurse case managers, physicians, home health workers, and, in some instances, a hospital pharmacist.

As community pharmacists who receive the discharge orders to fill, we consider ourselves to be part of that team, and so we take the time to evaluate and problem solve the discharge orders prior to the patient's arrival at the pharmacy.

If there’s any question about an order, we don’t hesitate to call the hospital and ask to speak to the discharge planning team. They’re more than willing to help us problem solve the issue.

Remember, you’re not calling and dumping the problem on them; you’re part of the team working with them to help resolve the problem in the best interest of the patient.

Conclusion

Community pharmacists perform social work all day long and cover many different situations. Each time we face a situation, we must remember that although we may have seen a similar situation many times before, this is the first time this particular patient has seen us for this specific problem.