Medical students' curriculum includes an intense course in Pharmacology were drug theory and application is taught at the basic science level.  For most physicians, the clinical application of pharmaceutical treatment started on the hospital wards when treating inpatients. In hospitals, Pharmacists review and manage the medication formularies and in learning centers they often round with (and are very much part of) the medical team.  At the residency level they contributed to case review and educating the resident staff on the various medication classes, indications for treatment of various diseases, dosing, toxicity and side effects. They are also involved in clinical trials involving new as well as established medications and treating medical diseases. They have an advanced degree and are part of the health professional team.

 

In the outpatient setting, the Pharmacist primary role remains one of filling out prescriptions ordered by licensed treating physicians. Licensed nurse practitioners and dentists may also prescribe certain prescriptions. The Pharmacist duties also include: checking for drug interactions when a new prescription is started, monitoring for allergy potential based upon a patient's prior allergy history, confirming proper dosing of medication being prescribed and avoiding duplication filling of medication.   If there is a medication allergy, use or dose concern, the Pharmacist should assist the patient in clarification preferably by direct communication with the treating physician.  Pharmacists are not diagnosticians and are not licensed to actually diagnose and treat disease.  You may consult them about over the counter medications to alleviate symptoms.  They may provide recommendations regarding your treatment or medication. You or they should bring any recommendations to the treating physician's attention for consideration in managing your case.  A Pharmacists input can only be potentially helpful for your care and thus won't be shunned by your physician.

 

In today's busy work environment, I have noticed the professional communication between physicians and pharmacists has become greatly impaired. Part of this is due to sheer customer volume.  Other issues contributing to this include: businesses ownership of pharmacist practices (CVS et al), 3rd party interference with prescription choices and confusion as it relates to patient care and oversight.

 

Patients often report they didn't fill a prescription because the pharmacist informed them their insurance plan "didn't approve it" or the patient felt the prescription is too expensive.  In my view this is not a proper response. Such clerical issues shouldn't delay treatment (the exception being preventive/long term medication decisions). As a rule, the prescription should be filled, the patient should initially pay for it if it "isn't covered" and then ongoing cost concerns should be settled when the involved parties can sort out the issues.  The physician has no reasonable way of knowing in advance what a particular patient's insurance plan is going to prefer within any medication class especially if a name brand product is necessary.  In the past quarter I have even witnessed patients being denied one generic medication due to a plan preferring a different generic medication.  

 

The patient  has some responsibility in their treatment as well and following are helpful tips to make your physician office visits more efficient. A formulary is a preferred medication list that your insurance company creates each year based upon prior demand as well as cost issues.  Usually formularies can be mailed to you at the time of insurance enrollment or downloaded from your insurance companies website and printed by computer  You can keep current prescription formularies on hand and bring them to your medical appointments. Bringing your formulary to your visit appointment will help the doctor be successful the first time in picking a "covered"/cost effective medication. Medication decisions are made at the time of an appointment with careful chart review. Such review includes going over present symptoms and the patient's response to recent changes.  Prior side effects from other medications and drug allergies are also routinely checked for.

 

I am hopeful the preceding paragraphs explain the role of your pharmacist as well as some helpful tips to make your health management safe and efficient. As stated prior attending your appointments with a current active medication formulary will help your doctor review your best options and make medication changes (if appropriate) as your are interviewed and evaluated during your actual appointment.  Often what we prescribe can be life saving but side effects/risk also are incorporated into prescription decisions.  Cost is always a factor but can not be the only factor.  We can not promise to always be able to provide a generic or less expensive medication for your particular illness or set of illnesses but certainly we are happy to do this whenever appropriate.