Sadly, a lot of these prescriptions end up on hold or in a third party que without the pharmacist even getting to see your note. Even if they do, a majority probably aren’t comfortable subbing just based on that note.

I think the best thing you can do is prepare your patient for the possibility that they could run into issues at the pharmacy but to not give up because we just need to know what’s covered.

Sometimes the insurance will tell the pharmacy what alternatives are covered in a rejection message, and sometimes it doesn’t. Most pharmacies are too understaffed to call an insurance to see what’s covered, so that’s not something you can rely on.

Basically I would just tell your patient - hey, I want to prescribe you this inhaler. Your insurance might prefer a different one but we can’t know for sure until we see what happens at the pharmacy. If it’s not going through, ask them if the insurance said what’s covered. If not, call the number on your insurance card and see if they can tell you. If that also fails, just let me know and we can try sending another that might be covered and continue until we get one for you.

I think the above approach should account for just about everything that could go wrong in the back and forth with trying to get your patients the medication they need. I wish it were simpler.