Specialty Pharmacy (4.0) 4.0

OPS 5-1: Prescription Order Review

Submited by: Tom Goddard

The Basics

This standard requires your pharmacy to implement written P&Ps addressing:

  • Verification of the prescription source;
  • The legibility of the prescription (and if it is illegibility, activities to clarify the prescription);
  • A drug utilization mechanism that addresses the full array of DrUM considerations; 
  • Communication with the prescriber and patient, as appropriate, to resolve any discrepancies regarding either the medication or benefit/coverage; and
  • Thorough documentation of all communications with the prescriber.

Management Tips

Your P&P should provide your pharmacists with clear guidance on how to perform each of the required functions. 
Prescription source verification will differ from one pharmacy to the next, but in any event should be documented. If the pharmacy receives prescriptions only from providers within the same network as the pharmacy, an online check will suffice, so long as that check is documented. If the prescriber is known to the pharmacist, that, too, should be documented. 
URAC lists the key DrUM considerations as follows:

  • Therapeutic appropriateness
  • Over and underutilization
  • Generic use
  • Therapeutic interchange
  • Duplication
  • Drug-disease contraindications
  • Drug-drug and drug-allergy interactions
  • Drug dosage ix. Duration of treatment
  • Drug misuse
  • Drug-age precautions
  • Drug-gender precautions
  • Drug-pregnancy precautions
  • Regulatory limitations
A "discrepancy" in the prescription might be a number of things, such as wrong dosage or a dosage not written for the way the drug is manufactured (pill size or injectable vs. tablet).

We cannot stress this too much: each of three activities needs to have a place in your system for documentation of the action by the pharmacist.

Accreditation Tips

Desktop Review
Your P&P will suffice as documentation at the desktop review phase, but only so long as it addresses all of the above issues.
Onsite Review
The reviewer will interview and observe the pharmacist who oversees the prescription order review process.

  • Core 3.4 / 06.29.2020

    CORE 40 - Health Literacy

    This standard, a new, experimental standard, suggests that your organization should have policies and procedures that address health literacy. In this context, the meaning of health literacy is, "The degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate decisions regarding their health." The three suggested...

  • Core 3.4 / 06.29.2020

    CORE 39 - Consumer Satisfaction

    This short standard requires that your organization have a mechanism to collect information about your consumers' satisfaction.This often is done in the form of customer satisfaction surveys, consumer complaints, and sometimes even focus groups. Find out what your organization does -- it's likely more than one mechanism.

  • Core 3.4 / 06.29.2020

    CORE 38 - Consumer Safety Mechanism

    One of the most important of the URAC standards is this one, which requires that the organization have processes to respond quickly to urgent situations that threaten consumers' well-being.Even though the standard speaks of "a mechanism", the reality is that it requires a system of mechanisms dealing with the full array of urgent situations that are likely to confront the applicant. You can see th...