How does a doctor's office send prescriptions to pharmacies?

Doctor’s offices must have hundreds of pharmacies in their computer databases. How do they manage to set people up with their prescriptions? And do they have specific members of the staff who do that?

How did it work in the days before computers, too?

They fax them to the number of the pharmacy you give them.

Most doctor offices now use an EHR (Electronic Health Record) system, and can deliver a prescription to your selected pharmacy electronically as well, thru that system. Prior to all the technology, fax was widely used, and still is today in some cases.

They use a software like ‘escript’ to convey the prescription to the pharmacy. There are built in safeguards to assure tamper-resistance and privacy. Such software is proprietary.

Aha! Something I know about!

First, a pharmacy is registered with the NCPDP (National Council for Prescription Drug Programs), and that gives it an identifier that is used to identify the pharmacy uniquely.

Then that pharmacy gets registered with a nationwide pharmacy network provider- the big one is SureScripts. Something like 95% of pharmacies are registered with them.

Once that’s done, a doctor’s office using software (usually an EHR/EMR) that interfaces with SureScripts (or a competitor) can choose a pharmacy in SureScripts and create an e-prescription to that pharmacy. Generally speaking, modern EHRs combine the actual e-prescription workflow with the recording of the prescription to save time, so the doctor literally e-prescribes it to you right then and there in a lot of cases as part of the visit.

Then, on the other end, the pharmacy’s software either checks SureScripts periodically or SureScripts pushes the prescriptions to the software (not exactly sure how that part works), and it’s there for the pharmacists to fill and/or review.

I used to work in healthcare IT; the company I worked for had a more convoluted version of the above, where in order to implement a clinical dispensing solution (i.e. doctors offices dispensing drugs), we basically had to register our clinics as pharmacies, and e-prescribe from our EHR to our clinical dispensing solution… in the same clinic.

Related question, then.

Does any given doctor’s office database have access to every pharmacy registered with the NCPDP? Like, say, I need to make an emergency visit to a specialist in Indianapolis the day before I fly back home to Los Angeles; can they fill the order in Los Angeles?

And would that run afoul of any rules or regulations, especially as it pertains to controlled substances?

Yup, at my workplace the EHR interfaces with SureScripts. A printout is optional if the patient requests one, otherwise it’s usually all electronic. We also have prescription pads for occasional use - these can be physically given to the patient or faxed to a pharmacy. Every pharmacy I know of will also allow clinical staff to call in prescriptions by telephone.

(There are special procedures for controlled substances.)


It seems to work both ways, since when I got a DPT booster at my pharmacy, it showed up on my electronic record of vaccinations received in my provider’s electronic system.

My experience with controlled substances in such circumstances is that my doctor could not prescribe it outside the state.

Not to hikack, but are all chain pharmacies connected the same way? Let’s say I run out of my asthma inhaler in Washington DC and my prescription is at Walgreens in Chicago.

That probably depends on the pharmacy chain. If they do transfer prescriptions between locations, it would be within their own software package, not through SureScripts.

I do believe Walgreens is connected like that though; we live in Dallas, and my wife needed a refill of something that she’d forgotten when we were on vacation, and was able to get the Walgreens in North Platte, NE to fill it for her based on her standing prescription at the Walgreens at home.

For security reasons, many emergency departments transmit information using a giant Bat Signal.

I know someone who has prescriptions for controlled substances and from what I’ve been told, they can’t be transmitted electronically to the pharmacy. Instead they have to visit the doctor’s office to pick up a paper prescription that they can take to the pharmacy.

Not any more, at least here in New York. For a controlled substance, I send an electronic message through the health system to the doctor, who approves it and sends the prescription electronically to the pharmacy.

My (Canadian) doctor is part of a clinic group that appear to have a complete electronic management system. All her records go onto computer, and she can also send to assorted pharmacies from there. Not sure how complete the list is, but I imagine all they need to do for the computer is enter the name and fax # of the pharmacy. Computers have been “printing” to a fax line for decades. I believe it has a scan of her signature to paste in.

Since I’ve not had to get any restricted drugs (i.e. serious painkillers) I don’t know if the process works for those. I would assume that there is some sort of check in place - pharmacy verifies by phone with clinic, or requires an actual paper prescription. that’s the only hole in the automated system, is ensuring certain prescriptions are valid. I imagine the number of people trying to scam blood pressure medication or topical cortisone cream is pretty low. However, before they were faxing she would print out a paper copy of my prescription for me to take to the pharmacy, presumably no different than what gets faxed now.

(My previous doctor, who retired two years ago, was old school and she wrote the prescription in legendary illegible doctor scrawl, by hand.)

(Should add - several provinces have medication monitoring systems, since doctors are paid by our medicare system. The computer tracks the patient and doctor prescribing certain medications, and flags patients or doctors who appear to be trying to abuse the system - patients doctor-shopping, or doctors who tend to prescribe too many of the restricted drugs.)

Just to add to this because I saw my doctor today for my yearly physical and she had to renew the one med I take, not a controlled substance. She took out her phone and used something on it to send an ID to the computer in the office to allow her to do Rx. When I asked her about it she told me my insurance allowed electronic prescriptions but it varied by insurance companies. Some companies still needed them to be sent by fax ( which she said the nurses hated because it was so time consuming), and there were a small amount of companies that wanted everything by fax, except for controlled substances which needed a written Rx.

My understanding of controlled substances, although this may just be my doctor’s office, is if it’s a short term thing, like a few days of oxy for dental work, or a couple of months of oxy for major surgery of some kind, fax or electronic are fine. It’s the long term pain killers where the doctor has to actually see the patient in person every 6 months, which I think is the law. This is also NY.

Mu (UK) doctor usually sends prescriptions to whichever pharmacy I have nominated. If that arrangement has not been set up, a patient will have to go to the surgery to collect a paper prescription and take it to any pharmacy for dispensing.

If I needed an inhaler urgently away from home but in the UK, I can go to a pharmacy and they will call my GP and get a prescription sent. If I was abroad, I assume that I would have to persuade a local doctor to prescribe for me (and pay whatever charges were appropriate).

My favourite!

Last time I went to pick up medicine for a cat, the pharmacist asked me to read the prescription out loud because she literally could not decipher a single word.

That’s probably dependent by state. For example, some states don’t allow for doctors’ offices to dispense medications, others have restrictions on controlled substance prescriptions.

Most however, put the responsibility more on the pharmacy than the prescribing doctor to police that. In other words, a doctor can prescribe what he wants, but the pharmacy is who has to make sure they don’t give out too much at once, or whatever. It almost certainly requires a call back to the prescribing provider saying “Hey Dr. X, you know that this patient has already been prescribed so much Tramadol- he can’t have more until 10 days are up” (or whatever), and then the Dr. will adjust his prescription/treatment plan accordingly.

The Doc gave you a paper script in the office, and you took it to your pharmacy and got it filled. Still happens this way sometimes, not often, but does.