ExCPT Test Prescription Dispensing Process 2 — Questions and Answers

Question 1: When verifying a new prescription, which of the following elements must the technician confirm is present on the written prescription?

Patient's insurance ID number
Date the prescription was written (Correct answer)
Patient's diagnosis code
Prescriber's DEA expiration date

Correct answer: Date the prescription was written

A valid prescription must include the date written (along with prescriber info, patient info, drug, dose, quantity, sig, and signature). The date is essential for validating the prescription and determining if it is still valid.

A legally valid prescription must contain specific elements: patient full name and address, date issued, drug name and strength, dosage form, quantity, directions for use, number of refills authorized, prescriber's name/address/DEA number (if controlled), and prescriber's signature. The date of writing is critical because prescriptions have legal validity periods (e.g., most Schedule II Rxs are valid for 6 months in many states; some states limit Schedule III-V Rxs to 6 months from issue date). Insurance ID and diagnosis codes are billing requirements, not prescription validity elements.

Question 2: What does 'sig' refer to on a prescription?

The prescriber's signature
The patient's allergies
The directions for use/administration instructions (Correct answer)
The drug's NDC number

Correct answer: The directions for use/administration instructions

'Sig' (from Latin 'signa' meaning 'write') refers to the directions for use — how, when, and how often the patient should take the medication.

The 'sig' (abbreviated from the Latin 'signa' or 'signatura' meaning 'let it be labeled' or 'write') contains the prescriber's directions for how the patient should use the medication. It includes dose, route, frequency, and any special instructions (e.g., 'take with food,' 'take at bedtime'). In the dispensing workflow, the sig is transcribed from the prescription to the prescription label. Common sig abbreviations include: po (by mouth), bid (twice daily), tid (three times daily), qid (four times daily), prn (as needed), ac (before meals), hs (at bedtime).

Question 3: A prescription is brought in for 'Synthroid 50 mcg.' The pharmacy only has levothyroxine 50 mcg in stock. What is the BEST action?

Dispense Synthroid from another location
Dispense levothyroxine 50 mcg with pharmacist approval for therapeutic substitution (Correct answer)
Tell the patient the prescription cannot be filled
Contact the prescriber to change the prescription to a different drug

Correct answer: Dispense levothyroxine 50 mcg with pharmacist approval for therapeutic substitution

Levothyroxine (generic) and Synthroid (brand) contain the same active ingredient. With pharmacist approval and appropriate DAW code, the generic can be substituted unless the prescriber wrote DAW 1.

Synthroid is a brand name for levothyroxine sodium. Without a DAW or brand-only instruction, pharmacists in most states can substitute the FDA-approved generic equivalent. Note: Thyroid medications have a narrow therapeutic index, and some prescribers do write DAW 1 due to concerns about minor formulation differences affecting TSH levels. If no DAW is indicated, the pharmacist makes the clinical decision and may consult the prescriber or counsel the patient on consistency (always use the same manufacturer). The technician must bring this to the pharmacist's attention.

Question 4: What is the 'fill date' on a prescription, and why does it matter?

The date the prescriber wrote the Rx — it determines validity period
The date the pharmacy dispensed the medication — used for refill calculations (Correct answer)
The date the patient picked up the medication
The date the insurance approved the claim

Correct answer: The date the pharmacy dispensed the medication — used for refill calculations

The fill date is when the pharmacy dispensed the medication. Insurance plans and DEA regulations use this date to calculate refill eligibility.

The fill date (dispense date) is the date the pharmacy actually prepares and dispenses the medication to the patient. This date is critical for: 1) Insurance refill calculations — the insurance plan uses the fill date plus the days supply to determine the earliest eligible refill date. 2) Controlled substance refill tracking — pharmacies track fill dates to prevent early refills of controlled substances. 3) Expiration dating — beyond-use dates on dispensed medications are often calculated from the fill date. The fill date may differ from the pick-up date if the prescription was prepared in advance.

Question 5: Which of the following is the FIRST step in the standard pharmacy dispensing workflow?

Prepare the medication label
Receive and review the prescription for completeness and validity (Correct answer)
Count and pour the medication
Conduct the final pharmacist verification

Correct answer: Receive and review the prescription for completeness and validity

The first step is to receive the prescription and review it for all required elements, potential forgery, patient allergies, and any obvious clinical concerns before entering data.

The standard pharmacy dispensing workflow follows a logical sequence to ensure safety and accuracy: 1) Receive prescription and verify completeness/validity (all required elements present, not expired, prescriber DEA # valid for controlled substances, no signs of forgery). 2) Patient profile review (allergies, current medications, insurance). 3) Data entry and label generation. 4) Drug utilization review (DUR). 5) Medication preparation (retrieve, count, pour). 6) Pharmacist verification/final check. 7) Patient counseling and dispensing. Skipping or reversing steps increases error risk.

Question 6: What information is typically required to process a third-party insurance claim for a prescription?

Patient's medical diagnosis and hospital ID
BIN number, PCN, group ID, and member ID from the insurance card (Correct answer)
Patient's Social Security number and employment status
Prescriber's state license number and NPI only

Correct answer: BIN number, PCN, group ID, and member ID from the insurance card

The BIN (Bank Identification Number), PCN (Processor Control Number), group ID, and member ID from the patient's pharmacy insurance card are required to route and process a pharmacy claim electronically.

Third-party pharmacy claims are processed electronically using the NCPDP (National Council for Prescription Drug Programs) standard. The key billing identifiers include: BIN (Bank Identification Number — 6 digits identifying the PBM/processor), PCN (Processor Control Number — routes the claim within the BIN), Group ID (employer group or plan), and Member ID (patient's unique identifier). These are printed on the patient's pharmacy insurance card. Other required fields include prescriber NPI, NDC, days supply, quantity, and DAW code.

ExCPT Test Prescription Dispensing Process 2

When verifying a new prescription, which of the following elements must the technician confirm is present on the written prescription?