Pharmacy risk management: Correct prescriber selection is essential

Key Points

The selection of an incorrect prescriber during the prescription order entry process may have consequences long after the prescription is filled. Pharmacists appreciate the pressures to process prescriptions accurately and to deliver the best customer service possible. There may be circumstances in which the name of the prescribing physician is unclear on the prescription. As a result, a decision may be made to select a prescriber who may or may not be the actual physician issuing the prescription.

Generic prescribing measures

Advocate Physician Partners (APP), a 3,600 member physician hospital organization (PHO) in the greater Chicago area, currently has 4 generic prescribing measures as part of a clinical integration pay-for-performance (P4P) model. These generic measures include overall prescribing, proton pump inhibitor prescribing, statin prescribing, and nasal steroid prescribing.

APP physician practices are encouraged to review their available prescription claims data at least quarterly and to identify opportunities for therapeutic interchange of generic alternatives for brand-name medications, when clinically appropriate. Physicians and practice managers frequently contact the APP pharmacy staff to report their incorrect assignment to prescriptions they never wrote, refilled, or authorized.

Causes of incorrect assignments

In our experience, such events primarily involve physicians with common last names such as Jones, Patel, or Smith, or large physician group practices using a single common printed prescription pad listing all the physician names.

There also have been cases in which retail pharmacies have juxtaposed prescriber DEA and/or NPI numbers among physicians with similar last names in their prescriber databases.

APP estimates that 1% to 2% of prescriptions are entered with an incorrect name for the prescribing physician. Assuming that a retail pharmacy fills 1,000 prescriptions per day, this means that 10 to 20 prescriptions per day may have the incorrect prescriber assigned. Although it may not seem like much, ultimately it may affect physician prescribing measures such as generic dispensing rates and compensation arrangements by which physicians are paid for performance.

Also, the emergence of accountable care organizations may involve retrospective claims review for physician "grading" based upon measures than include brand and generic prescribing. The claims data must be "trusted" to be valid in order for appropriate decisions to be made.