You Prescribed It. Did the Patient Ever Start It?

A patient can arrive for a medication follow-up without having taken the first dose. The practice has an approval on file, but the patient is still waiting for an answer about cost, a pharmacy call, or help with an injection.

Part of that visit then becomes a conversation about getting started. A check before the appointment gives the team a chance to help and lets the clinician know what the patient has actually used.

In one acne study, 27% of patients had not obtained every prescribed treatment.

We covered why drug authorization remains its own problem. This week, let's follow the prescription past approval.

Approval means the payer authorized treatment, and dispensing means the pharmacy supplied the medication. Starting means the patient actually began using it. Those are separate events, and a closed prior authorization task only tells you about the first. The medication may be in the patient's refrigerator while they wait for help with the first injection.

Imagine a patient with psoriasis who misses a specialty pharmacy call while at work. They're unsure what the medication will cost and have questions about giving themselves an injection. The practice may be waiting for the pharmacy to arrange delivery while the patient is waiting for someone to explain the next step.

Start with: "Were you able to get the medication, and have you started it? Is there anything we can help with?"

If they haven't started, ask about the cost they've been quoted and whether they've connected with the pharmacy. Leave room for injection questions, concerns about side effects, or uncertainty about treatment itself. Ask what would make the next step easier. Before ending the call, agree on who will contact whom next and a good time to reach the patient.

Try this with one clinician's new psoriasis prescriptions over 2 weeks. Name an owner and a backup who can use the same EHR task list. Start with a protected 15-minute block each workday and adjust it to the workload. The practice manager should help make room in the schedule so the owner can finish a pharmacy call or reach a patient without juggling another task.

At the authorization handoff, record approval, dispensing, and the patient's start status separately. Give each open case a next action and a date. For example: "Oct 28: call the pharmacy about the quoted cost, then update the patient." That gives the backup enough information to pick up the work when the owner is out.

Have the clinician and patient agree on a checkpoint for confirming whether treatment has begun. Set the timing around that patient's treatment plan and readiness. Record the actual start date when known. The checkpoint gives the team a reason to check in even when the next office visit is weeks away.

Agree on clinician-approved escalation before starting the trial. Staff can help with access barriers; the clinician decides treatment changes and intentional holds, and the patient's choice to decline deserves respect. A hold or a decline is a valid outcome, not a failure. Medical urgency cannot wait for a routine check-in: route urgent concerns immediately through the practice's established clinical triage process.

At the agreed checkpoints, count confirmed starts and keep pending, held, declined, and unknown visible beside them. Include every patient whose checkpoint has arrived. A start is confirmed when the patient reports beginning treatment or the clinical record documents administration. Note who confirmed it and when. A pharmacy delivery or a closed authorization alone doesn't confirm use. This measures starting treatment, not whether the patient keeps taking it.

If the practice hasn't reached the patient, keep the status unknown and follow the agreed outreach plan.

Bring that information into the next visit. When treatment has begun, the clinician can assess the patient's actual experience and response with the start timing in view. When it hasn't, the clinician can see the barrier already identified and the help offered. The clinician walks in knowing whether the patient has started and, if not, what's blocking them.

At the end of the trial, look for one change that would make the handoff easier. If patients missed unfamiliar pharmacy calls, add the pharmacy's name and expected contact to their visit instructions. Use what the small group teaches you to improve the next handoff.

Clarity RCM manages revenue cycle for 200+ dermatology practices across 44 states. It's all we do. See how we work.