Prescription pathways 

By Katharine Russo, PharmD, Johns Hopkins Medicine 

In an increasingly complex healthcare landscape, one of the most overlooked aspects of outpatient care is knowing where our patients fill their prescriptions. In today’s age, there are big chain pharmacies, independent community pharmacies, mail order pharmacies, and online discount pharmacies like Marc Cuban’s Cost Plus Drugs. While clinicians focus heavily on diagnosis, treatment, and monitoring, the journey from prescribing to medication-in-hand is just as critical. Knowing the pharmacies within your clinic’s community, how they operate, what services they offer, and which may best suit specific patient needs, can significantly improve safety, medication adherence, and overall patient experience. 

Understanding the journey from prescribing to medication-in-hand is just as critical as the diagnosis behind the prescription.  

1. Medication access and medication adherence 

Pharmacy choice affects more than convenience. Factors like hours of operation, delivery services, refill synchronization, stock variability, and most importantly, cost, can make or break a patient’s ability to start and stay on medications. Clinicians who understand these variables can help prevent delays and treatment gaps. 

2. Insurance and cost considerations 

Pharmacies differ widely in how they manage prior authorizations, copay assistance, discount programs, and formulary navigation. Insurance often dictates where patients can fill their prescriptions—opting for a non-preferred pharmacy can result in quantity limitations and cost differences. Not all pharmacies are contracted to bill Medicare Part B for supplies like glucometers and continuous glucose monitors. Recommending a pharmacy that’s preferred with their insurance and has the capability to bill Medicare Part B can reduce sticker shock and improve medication adherence. Mail order pharmacies often limit patient’s ability to utilize manufacturer co-pay cards to receive further discounts for commercially insured patients.  

3. Safety in care transitions

Medication errors often arise between prescribing and dispensing. Knowing the pharmacies your patients use helps you anticipate communication patterns, clarify instructions, and resolve issues faster. This is especially crucial for high‑risk therapies (anticoagulants, titrated medications, controlled substances, biologics, etc.). Consider selecting in-house pharmacies to allow for improved communication and clinical review of medications for your patients.  

4. Enhanced care coordination 

Community pharmacies are frontline healthcare access points. When clinicians build relationships with trusted local pharmacists, communication becomes easier and more efficient, leading to faster interventions, fewer therapy interruptions, and more cohesive patient care. 

How to build knowledge about local pharmacies: Map your community’s pharmacy landscape:

1. Make a list.  

Start with a simple list of pharmacies commonly used by patients in your clinic including large chains, independents, specialty pharmacies, 340B or health-system-owned outpatient pharmacies, mail order, and discount pharmacies. 

2. Identify each pharmacy’s strengths and services. 

Not all pharmacies function the same. Consider capturing: medication availability trends (e.g., ADHD medications, GLP‑1s), turnaround times for new prescriptions and refills, immunization availability, delivery/curbside pickup options, packaging and medication adherence tools (blister packs, med synchronization), specialty medication handling, and multilingual services/interpreter availability. 

3. Ask patients where they prefer to fill prescriptions.

A simple question during medication review, “Where do you usually get your prescriptions filled?” provides essential continuity information. Document the patient’s preferred pharmacy in the EHR and verify it regularly. Patients may prefer to fill their medications at multiple pharmacies. While one pharmacy may be preferred, ensure there’s a good understanding of which medications should be sent to each pharmacy.  

4. Build relationships with key pharmacy contacts 

Encourage your team to: identify “go‑to” contacts at frequently used pharmacies; establish direct communication pathways for clarifying prescriptions; understand each pharmacy’s workflow and preferred communication methods. 

These relationships become invaluable during urgent medication changes or when resolving insurance issues. 

How your clinic’s pharmacist can support you: 

Pharmacists bring a unique set of skills and resources that make them ideal partners in this process. Your clinic’s pharmacist can: 

1. Assist with medication access problems.

Pharmacists excel at navigating formulary alternatives, prior authorization requirements, copay/medication assistance programs, medication shortages, and therapeutic alternatives. They can quickly recommend pharmacy options that fit the patient’s insurance and clinical needs. 

2. Provide education and workflow enhancements. 

Pharmacists can train clinicians and staff on: e‑prescribing best practices, reducing prescription callback rates, writing prescriptions that minimize confusion (e.g., for titration packs or complex dose changes), and optimizing EHR tools to select pharmacies accurately. 

3. Strengthen communication with community pharmacies.

As medication experts, pharmacists speak the same “language” as dispensing pharmacists. They can: resolve dispensing issues, clarify instructions, coordinate care for complex cases, and build stronger interprofessional networks. This creates smoother transitions and fewer care disruptions. 

When clinicians understand the pharmacies in their community, and when they partner closely with their clinic pharmacist, the result is better care, fewer delays, and more satisfied patients. By leveraging the expertise of pharmacists and building strategic knowledge of local pharmacy resources, clinicians can significantly enhance medication access, safety, and adherence. 

This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.