(1335) Diagnosis Codes Included on Prescriptions Transmitted to Chain Community Pharmacies: A Retrospective Analysis

Objectives: The primary objective of this study is to determine the proportion of electronic prescriptions sent to a midwestern-based chain pharmacy that contain a diagnosis code(s). The secondary objective is to identify factors that impact whether a diagnosis code(s) is (are) recorded on electronic prescriptions sent to the chain pharmacy. Several studies have demonstrated that the quality of drug utilization review is improved when community pharmacists are provided with immediate access to this data.

Including diagnosis codes on prescriptions sent to community pharmacies can be one of the easiest and most efficient ways prescribers can communicate patients’ specific disease states to pharmacists. The Centers for Medicare & Medicaid Serves requires documentation of diagnosis codes on prescriptions for Medicare Part B claims, and some state laws mandate this documentation on prescriptions for drugs in specific therapeutic classes, such as opioids. However, federal law does not require prescribers to record diagnosis codes on prescriptions, including those for controlled substances. Despite the simplicity of the process, barriers do exist to this type of documentation on prescriptions, including hesitation from both prescribers (especially if prescribing a drug for off-label use) and pharmacies (concern that miscoding may result in decreased or lack of reimbursement). The goal of this study is to identify trends in the presence or absence of diagnosis codes recorded on prescriptions written and sent to chain pharmacies use to identify opportunities to improve documentation of medical information in pharmacy software systems as well as the quality of pharmacists’ drug utilization review process.

Methods: This is a retrospective, multi-site cohort study using review of electronic pharmacy software records. Prescriptions received and processed by all pharmacy locations within the company between June 1, 2022 and December 31, 2023 will be reviewed for the presence or absence of a diagnosis code(s). Only electronically transmitted prescriptions will be included in the analysis. Refilled prescriptions and prescriptions with diagnosis code(s) manually added by a pharmacy team member after the prescription was received will be excluded. For the primary objective, prescription data will be reviewed for the presence or absence of diagnosis code(s) indicated on the prescription by the prescriber upon transmitting to the pharmacy. The proportion of prescriptions with a diagnosis code will be calculated by quantifying the number of prescriptions containing a diagnosis code over all eligible prescriptions received during the study period. For the secondary objective, the dependent variable will be the presence or absence of diagnosis code(s) documented on each prescription, and the independent variables will include prescription date, day supply, refills authorized, and drug (controlled versus non-controlled, legend versus non-prescription, specialty versus non-specialty, and therapeutic class), patient (gender, age, zip code), and prescriber (physician vs. mid-level practitioner, specialty/subspecialty, and zip code) characteristics. Data will be analyzed using both descriptive and inferential statistics.

Results: Research in progress.

Conclusions: Results of this study will identify what proportion of electronic prescriptions sent to a midwestern-based chain pharmacy contain a diagnosis code(s) in the past eighteen months. In addition, the results may identify certain patient, drug, and/or prescriber characteristics that impact whether diagnosis code(s) are recorded on electronic prescriptions sent to chain pharmacies. This will provide valuable information in understanding the data available for pharmacists to conduct drug utilization reviews.