Primary care doctors regularly field calls after hours from pharmacies and patients who run into trouble getting new or refill prescriptions. It’s a frequent source of lost time and frustration for everyone involved. Patients often tell me they hear the dreaded voicemail from the pharmacy that there is a “delay” on their prescription. After 20 years working as a primary care doctor, I’ve heard the same issues about prescriptions over and over and have laid out some solutions for you.
1) My insurance won’t cover my prescripton.
If this is a new or refill generic medication for you, check the cash pay price at GoodRx right off the bat. This will allow you to pay for it without having to embark on a prior authorization process with your doctor. You’ll be surprised to see how cheap most medications are.
The same goes for a new prescription of a one-time thing like seasick patches, antibiotics, or sleep medication. Just ask the pharmacist if you can pay cash for it, so there’s no delay.
If it’s a new prescription that will be ongoing (for example, oral contraceptives, overactive bladder medication, high blood pressure meds, or diabetes meds), contact your doctor right away to get the prior authorization.
2) My insurance said it’s too soon to fill my prescription
I get this call all the time, and patients interpret this as a law or something written in stone. It’s not (unless we’re talking about controlled substances, like opioids). Your insurance company won’t pay for a fill this soon, but with a doctor’s prescription, you absolutely can get it filled. This may happen if you’ve changed from one medication to another (like a new form of birth control or dosage of blood pressure meds) and you’ve filled a prescription for the previous medication in the past 30 days. Again, just ask to pay cash for it after you’ve checked GoodRx.
3) My pharmacy says I can’t get a 90-day fill
If the doctor has written you a 90-day prescription, you can absolutely get it filled. Again, it’s just that some insurance companies won’t pay for 90 days at a time. If you’ve checked with your doctor and they’ve written a prescription for 90 days at a time with refills, tell the pharmacist you’ll pay cash for it (if it’s affordable) and not use your insurance.
4) The pharmacist wouldn’t fill my prescription because there’s a drug interaction
This one is a frequent offender over the weekend, especially with antibiotics. Over the weekend, it’s more difficult for pharmacists to reach a doctor’s office, so they’re more likely to put a hold on the prescription.
This warning is often triggered in folks taking warfarin (Coumadin) or those taking two medications known to affect the heart’s electrical activity. These risks are minimal, and if your doctor prescribed this medication and is aware of the interactions, the prescription should be filled.
If you can’t get an important prescription, don’t leave the pharmacy without it. Instead, ask the pharmacist to call your doctor’s office or call the doctor’s “on-call” service to get approval.
5) The pharmacy has that on back order
If this happens and the pharmacy can’t order it and get it for you soon, check if other nearby pharmacies have it in stock. You don’t have to go without it.
6) My medication was discontinued or there’s a shortage—now what?
The very common blood pressure medication losartan (Cozaar) was plagued by this in 2020. Call the doctor’s office or after-hours number so they can prescribe you a different drug before you run out of blood pressure medications.
7) It’s a weekend, so the pharmacy can’t get approval for my prescription
Patients say this comes as a voicemail from the pharmacy saying there is a “delay” in one of their prescriptions. If you are heading into the weekend without your diabetes, blood pressure, or heart medication, first look at the cash price on GoodRx. If it’s reasonable, pay cash and skip the delay.
If the cash price is too high, call the doctor’s exchange if it’s after hours or the weekend (trust me, I get that call all the time). Your doctor can approve a similar drug in the class or try and accelerate approval. Don’t go a week without it.
8) I’m leaving town for the summer—can I get a 90-day supply?
Yes, you can. If you are leaving for an extended period of time and have a medication you’ve been on for a while (like birth control, blood pressure, or an antidepressant), ask your doctor to approve 3 to 6 months of your medications.
Again, you may have to pay cash for some of it (these are roadblocks your insurance company has put on, not a “law”), but you absolutely can get enough of your medications if your doctor approves it.
9) I went to get my COVID vaccine, and they asked me about all my other vaccines
I appreciate that pharmacies provide vaccinations, but patients have occasionally been told they need vaccines when they don’t. An annual flu shot is great, but please ask your primary care doctor if you are due for a Prevnar or Pneumovax (both pneumonia vaccines), Shingrix (shingles), or Tdap (tetanus, diphtheria, and whooping cough) before you get one. I have many folks who’ve gotten duplicates.
10) I lost my prescription medications—what can I do?
If you’ve left a routine medication somewhere or lost it and the pharmacy tells you they can’t fill it, yes, they can. Ask your doctor for a refill. You may have to pay cash for it, but this is an easy fix.
This advice does not apply to controlled substances, which will be trickier and often require a visit with your doctor. Most doctors won’t refill a controlled substance for a lost prescription without seeing you first.
I hope these help.
Dr. O.
I am a Clinical Associate Professor of Medicine at the Keck School of Medicine of USC and a board-certified Internal Medicine physician. For 20 years I’ve had an active private practice in general internal medicine currently at The Doctors of USC Beverly Hills. I am lucky to spend part of my time as the attending physician for medical students and residents during their rotations at LAC+USC Medical Center. I’ve been a medical advisor on leading health social networking sites including Dailystrength.org and Sharecare and currently serve as the medical advisor and blogger for GoodRx.com, a prescription drug price comparison website, and GoodRx care powered by Hey Doctor.
My philosophy of care centers around seeing things we can see coming, and nailing them head-on. I appreciate the idea of sharing power and responsibility for the choices one makes for prevention, treatment, and investigation into medical problems. My hope is to write blog posts to empower patients to navigate their own health by laying out the ways that medicine can guide you with strategies to investigate, prevent, and treat some common medical issues, big and small.
I have appeared on The Doctors, Fox Sports West, The Ricki Lake Show, as well as many local news outlets and have been featured in numerous online and print publications. I am a fellow of the American College of Physicians and honored to be named “Top Doctor” in Los Angeles and Pasadena Magazine for years.