1. Medication Order Entry and Filling
Pharmacy Technician Tasks
Accepting new prescriptions from patient
New telephoned prescriptions in some states, NY included, are not permitted to be accepted by pharmacy technicians
Receiving refill requested from the patient
Calling doctor’s office for refill authorizations
Collecting patient’s data
Maintaining patient’s profiles

2. First step in order entry
Receiving the prescription. According to federal law, a prescription may be transmitted to the pharmacy in the following ways (controlled substances may differ and state laws also apply)
Written
Telephoned
Faxed
Electronically, e-prescribing
Step 2
Obtain patient and prescriber information
Patient information includes full name, address, contact, date of birth, any drug and food allergies, medical history
Prescriber’s information
Name and address with contact
DEA (required for controlls)
NPI (required for most insurances)
Registration/license (required by some insurances)

3. Step 3 Data input into electronic patient profile
Name, address and other demographic data
DOB
Medical history
Drug allergy information and Food
Prior Medication/OTC/Herbal use
Drug selection
NDC of the drug chosen must match the one entered into the computer
Determining if a generic can be used
Keying in direction data
Entering refills
DAW codes

4. DAW Codes
DAW codes are used by insurances companies to help determine the reimbursement to the pharmacy and if the medication is eligible for full or partial coverage
These codes are universal and used by all pharmacies and insurance companies
Codes are not required to be memorized for the exam but know the following
DAW=0 means no preference is indicated (generic ok)
DAW=1 means prescriber indicates brand drug to be dispensed
DAW=2 means that generic is ok but patient requires brand
DAW=8 generic is ok but generic is not available in market

5. Step 5: Generating the label
Submitting the prescription claim to the insurance company for payment. This online claim processing is called adjudication
Step 5: Generating the label
the following on all retail prescription labels affix to the container
Pharmacy full information, including telephone
Patient, prescriber, and drug name (state)
Strength of the medication
Direction for use
Quantity dispensed
Date prescription was filled or refill
Rx number
Initials of the RPH
Number of refills
Manufacturer of drug (new amendment)
Expiration date of prescription
Step 6 affix auxiliary Label to product
Provide additional info to patient
Common labels
Avoid Alcohol: example Metronidazole
May cause drowiness: BDZ (Xanax); antihistamines (Bendryl)
Take with food or milk : example NSAIDS, (ibuprofen, diclofenac)
Shake well: all suspensions (including eye drops) Augmentin, Amoxicillin

6. Sample Label on Retail Prescription Vial
Milan Pharmacy
1600 Broadway
New York, N.Y
John Doe Rx#
1 Central Avenue, Ridgewood, N.Y (optional) Date filled: 03/5/2015
Date Rx written: 03/4/2015 (optional)
Simvastatin 20 mg
Take one tablet by mouth every day
Qnty: Refills: 11
Prescriber: Dr. Jane Doe
RPH: Milan Topalov
Drug: Simvastatin for Brand Zocor
Manufacturer: Dr. Reddy’s
NDC: (optional)
Prescription Expiration: 03/5/2016

7. Step 6
Select the container of dispensing. Most drugs are light sensitive and their dispensing in amber colored containers are required
Vials for capsules and tablets
“Ovals” are wide mouthed containers for compounded creams and ointments
Glass or plastic amber bottles for liquid medications
Some drugs require the original manufacturer labeled container to be dispensed. A very important one (hint: it may be on the PTCE) is Pradaxa ® (Dabigatran) is a anticoagulant used in place of warfarin for many condition. FDA in 2011 requires that the pharmacist dispense drug in the original container and the bottle be dated 60 days after opening
Step 7
Pharmacist check. Labeled container with the pulled bulk medication and the original prescription

8. Step 8: Dispensing to patient
For all new patients to your pharmacy it is important to give them a copy of the HIPPA notice of privacy practices and to document that the patient received it; same holds true for doctor’s office
As per OBRA 90 requires, the pharmacist must offer counseling
Use of teaching sheets that provide preset information in layman’s term of the medication
Some medications require a patient package insert or PPI to be dispensed with the prescription as per Federal law. These medication classes include:
Oral contraceptives (birth control)
Estrogen and progesterone products (menopausal products)
Isotretinoin (Accutane)
Metered dose Inhalers
PPI are laymen terms for what is contained in the Package Insert
All dispensed prescriptions must comply with the poison prevention packaging act of 1970
Child resistant caps on all dispensed vials

9. Institutional Fill Process
Hospitals, nursing homes, LTCF, etc follow the same procedures with some differences:
Ambulatory (out patient prescriptions) are not filled
Patient’s data is not collected but is available on the electronic patient’s profile
Patient’s name, demographics, height, weight, address, DOB
Patient’s insurance information
Patient’s Diagnosis
Patient’s allergies
Patient’s laboratory data
Admission date
Admitting physician
MAR
Medication reconciliation record
Dispensing to the patient directly is not done. Medication are administered by an RN

10. Dispensing to the patient’s nursing unit:
Hand delivery to the unit by the pharmacy technician from a centralized pharmacy
Technicians deliver unit dose medications to a ADC (automated dispensing cabinet). The medication is accessible to the RN from the cabinet after the medication is profiled by the pharmacist.
Support a decentralized pharmacy system with specialty satellite pharmacies (cardiac ICU unit would stock cardiac medications in their ADC)
supports with turn around time
Supports pharmacy antidiversion efforts
Omnicell and Pyxis Medistation are the industry standards