Pharmacy Required to Inform Physician When a Prescription Requires Pre-Authorization

pharmacyRecently, a state appellate court issued a very interesting and important opinion in a pharmacy error case discussing a pharmacist’s duty to inform a prescribing physician when a patient attempts to fill a prescription that required pre-authorization from the patient’s insurance company. Ultimately, the court held that pharmacies have a limited duty to notify both the patient as well as the prescribing physician each time a patient attempts to fill a prescription requiring pre-authorization.

The Facts of the Case

When the plaintiff was 18 years old, she suffered her first seizure. She was taken to the hospital and given a dose of Topamax, an antiepileptic medication. After discharge, the plaintiff saw a neurologist who recommended she continue taking Topamax and wrote her a prescription.

The plaintiff filled the prescription without incident until her 19th birthday. However, when she went to fill the prescription after turning 19, the pharmacist informed her that her insurance company required pre-authorization for Topamax prescriptions for patients over 18 years of age. The pharmacist told the plaintiff that they would follow up with her physician in order to obtain the required pre-authorization. Although not required to do so by law, the pharmacy routinely sent a fax to prescribing physicians offices when a patient tried to fill a medication that required a pre-authorization.

The plaintiff’s physician never received a request. On several occasions, the plaintiff and her parents tried unsuccessfully to get the pharmacy to contact the physician’s office in hopes of obtaining the pre-authorization. The pharmacist on staff would either tell her that they would call or that it was up to her physician to get the pre-authorization back to the insurance company.

Not able to afford the high cost of the medication, and unable to get the pre-authorization completed in time, the plaintiff stopped taking Topamax in August 2009. In September, the plaintiff suffered a second seizure. She was admitted to the hospital, given a small amount of Topamax, and released. The plaintiff and her family members continued to unsuccessfully try to obtain the pre-authorization and was told that she would need to pay the approximately $400 for the medication and then seek reimbursement. Still unable to afford the medication, the plaintiff did not fill the prescription. In October, she died after suffering a third seizure.

The plaintiff’s family members filed a personal injury lawsuit against the pharmacy, claiming that the pharmacy violated a duty of care to inform the plaintiff’s physician of the required pre-authorization. The court agreed, noting that, in this situation a pharmacy has a “limited duty to take reasonable steps to notify both the patient and her prescribing physician of the need for prior authorization.”

Have You Been the Victim of a Pharmacist’s Negligence?

If you or a loved one has recently been injured due to a Maryland pharmacy error, you may be entitled to monetary compensation. The dedicated Maryland personal injury lawyers at the law firm of Lebowitz & Mzhen, LLC have decades of experience representing injury victims in a wide range of Maryland, Virginia, and Washington, D.C. personal injury cases. To learn more, and to schedule a free consultation with an attorney to discuss your case, call 410-654-3600 today.

More Blog Posts:

Steps That All Pharmacists Can Take to Reduce Dispensing Errors, Pharmacy Error Injury Lawyer Blog, July 16, 2018.

Study Notes an Increase in Accidental Overdoses from Cancer Drug, Pharmacy Error Injury Lawyer Blog, July 2, 2018.

Photo Credit: Juan C / Shutterstock.com

Contact Information