Medication Order Processing and Dispensing
Building a valid prescription
Screen every order for patient identifiers, drug name, strength, dosage form, quantity, complete directions, date, refills, prescriber signature, and-for controlled substances-a valid DEA number. Verify the DEA check digit: add digits 1, 3, and 5; add digits 2, 4, and 6 and double that sum; add both totals; the last digit must equal the seventh digit. Technicians confirm completeness and authenticity; the pharmacist confirms clinical appropriateness.
The workflow
Intake and data entry, then drug utilization review for allergies, interactions, dose, and duplication, then claim adjudication, filling and labeling, pharmacist verification, an offer to counsel, and will-call storage. Unclaimed prescriptions are returned to stock on a defined schedule with the claim reversed and the action documented.
Days supply math
Days supply equals quantity dispensed divided by maximum daily use. For 60 tablets with 1 tablet by mouth three times daily as needed, the maximum is 3 per day, so the days supply is 20. Plans reject claims when days supply conflicts with quantity or with a plan limit.
Traps
- Missing strength or an as-directed sig, which makes days supply guesswork.
- Do-not-fill-until dates, PRN quantities, and taper directions.
- Transfer rules for controlled substances vary by schedule and state-confirm with the pharmacist.
- Confusing a prescriber's agent with authority to change therapy; only the prescriber may change a prescription.
- Skipping documentation of DUR overrides.
Worked example
A Schedule II order for 90 tablets with 1 tablet three times daily yields a 30-day supply. If the plan limit is 30 days the claim should pay; a rejection signals a data entry error, not a reason to switch the patient to cash.
Rule of thumb: if the quantity, the sig, and the days supply do not agree, stop and fix the data before adjudicating.