CPAP Module 19, Section 1: Communicating Effectively with Prescribers
MODULE 19: INTERPROFESSIONAL COLLABORATION

Section 1: Communicating Effectively with Prescribers

Translating Your Clinical Expertise into Persuasive, Actionable Recommendations.

SECTION 19.1

Communicating Effectively with Prescribers

From Clarification Calls to Collaborative Consultations.

19.1.1 The “Why”: Evolving from Gatekeeper to Clinical Partner

In your community pharmacy practice, your communication with prescribers has been honed into a sharp, efficient tool, primarily for the purpose of ensuring safety and accuracy. You are an expert at the clarification call—”Is this the correct dose?”, “Did you intend to write for this quantity?”, “Can I have a diagnosis code for this test strip?”. This role is fundamentally one of a gatekeeper. You are the final, critical checkpoint preventing errors from reaching the patient. This is an indispensable function, and you perform it with exceptional skill.

As a Certified Prior Authorization Pharmacist (CPAP), your relationship with prescribers must undergo a profound evolution. While you will always be a guardian of safety, your primary function now shifts from gatekeeper to clinical partner and strategic consultant. You are no longer just asking for clarification; you are providing solutions, presenting evidence-based arguments, and guiding prescribing decisions to align with both clinical best practices and the complex realities of payer policies. The prescriber is no longer just a voice on the phone to be queried; they are your most important collaborator in navigating the access landscape.

This change in dynamic is the single most important skill you will develop in this role. Prescribers are highly trained, intelligent professionals operating under immense time pressure. They are juggling patient care, documentation, and a thousand other administrative burdens. A prior authorization is often seen as another one of those burdens—a frustrating, bureaucratic hurdle. Your communication must be so effective, so efficient, and so clinically valuable that you transform their perception of the PA process. You are not the source of the problem; you are the expert who brings them the solution. When you call, they shouldn’t think, “Oh no, another PA problem.” They should think, “Good, the pharmacist is on the line. They’ll know what to do.”

Mastering this means understanding the prescriber’s world: their clinical priorities, their time constraints, and their communication preferences. It requires a new level of preparation, a structured approach to presenting information, and the confidence to make clear, evidence-based recommendations. This section will deconstruct that process, providing you with the frameworks, scripts, and strategies to build collaborative relationships and ensure your clinical recommendations are not just heard, but actively sought after and implemented.

Retail Pharmacist Analogy: The High-Value OTC Consultation

Imagine a patient approaches your pharmacy counter with a complex problem. They have severe, persistent heartburn, have tried multiple OTC products with no relief, and are now considering a very expensive, behind-the-counter option. Your interaction can go one of two ways.

The Gatekeeper Interaction: The patient asks for the product. You ask the mandatory screening questions. “Have you spoken to a doctor about this? Are you taking any other medications?” You sell them the product. You have fulfilled your basic safety duty. This is the equivalent of a simple clarification call.

The Clinical Partner Interaction: You see this not as a transaction, but as a consultation. You step out from behind the counter. You ask open-ended questions. “Tell me more about what you’ve tried. When does it usually happen? What makes it worse?” You quickly assess their symptoms and history. You realize they have several red-flag symptoms that warrant a physician visit. Instead of just selling the expensive product, you say, “Based on what you’re telling me, while this product might help a little, I’m more concerned there might be something else going on. The most effective next step would be to see your doctor. I’m going to write down my specific concerns for you to share with them. In the meantime, let’s try a more targeted, less expensive initial therapy that won’t interfere with any tests they might want to run.”

In the second scenario, you have transformed the interaction. You didn’t just check a box; you provided clinical value. You saved the patient money, guided them toward a more appropriate level of care, and armed them with the information they needed to have a productive conversation with their doctor. You built trust and established yourself as a true healthcare expert. This is the exact mindset you must bring to every single interaction with a prescriber in your new role. Your job is not to ask “Can I have a PA?”; it is to present a comprehensive solution that makes the prescriber’s job easier and gets the patient the right therapy faster.

19.1.2 The Foundation: Preparation and Understanding the Prescriber’s Perspective

Effective communication begins long before you pick up the phone or send a message. A rushed, unprepared call to a busy clinician is destined to fail. It wastes their time, undermines your credibility, and leads to frustration for everyone. Every interaction must be built on a foundation of meticulous preparation. You must become a master of the case file, able to anticipate questions, understand the clinical context, and have all relevant data at your fingertips.

Before any communication, you must adopt the prescriber’s perspective. What is their goal? To provide the best possible care for their patient. What is their primary constraint? Time. Every second you spend on the phone with them is a second they are not spending with another patient. Therefore, your communication must be a model of efficiency and clinical relevance. They don’t need to know the intricacies of the payer’s portal or the specific rejection code; they need to know what clinical information is missing and what their options are. Your preparation is your sign of respect for their time.

The Pre-Call “Five-Point” Dossier

Never initiate contact with a prescriber without having reviewed and synthesized these five key areas. You should be able to recite this information from memory or have it immediately visible on your screen.

  1. Patient Demographics & Plan Information: Who is the patient and who is the payer? Have the correct member and group numbers ready. Nothing erodes credibility faster than having the wrong patient file open.
  2. The Exact Prescription & The Rejection: What is the specific drug, dose, and frequency being requested? What was the exact reason for the PA requirement? (e.g., “Non-formulary,” “Step therapy required,” “Quantity limit exceeded”).
  3. The Patient’s Clinical Story: What is the diagnosis? What is the relevant medical history? This is the most important part. You must be able to summarize the patient’s condition and the rationale for the prescribed therapy in one or two sentences.
  4. The Payer’s Policy/Guideline: You must have the payer’s clinical policy for the requested drug pulled up and reviewed. What are the specific criteria for approval? What are the required tried-and-failed therapies? You must know the rules of the game before you can play.
  5. The “Ask”: What is the specific action you need from the prescriber? Do you need them to provide chart notes from a specific date? Do you need them to confirm a past medication trial? Do you need them to consider a formulary alternative? Your call must have a clear, singular purpose.

Understanding Communication Styles and Hierarchies

Just as you adapt your counseling style for different patients in the pharmacy, you must adapt your communication style for different clinical environments. A conversation with a Medical Assistant (MA) in a busy primary care office is very different from a discussion with a fellowship-trained oncologist at a major academic medical center. Understanding these nuances is key to building effective working relationships.

Clinical Counterpart Typical Priorities & Constraints Effective Communication Strategy Common Pitfall to Avoid
Medical Assistant (MA) / Nurse (RN/LPN) in a Clinic Task-oriented, managing high volume of patient calls and administrative requests. May not have deep clinical knowledge of the specific case. Follows provider-directed protocols. Be clear, concise, and directive. “Hi, this is [Name], the pharmacist working on a PA for Jane Doe. I need the chart notes from her visit on October 10th showing her trial of metformin. Can you please fax them to [Number] and include this reference ID?” Provide a clear, actionable task. Asking them for clinical judgments they are not qualified to make (e.g., “Do you think the doctor would consider switching to Jardiance instead?”).
Specialist Physician (e.g., Cardiologist, Oncologist) Highly focused on their specific domain. Evidence-based and data-driven. Extremely time-sensitive. Values peer-to-peer discussions. Lead with your clinical assessment. Be prepared for a high-level conversation. “Dr. Smith, this is [Name], the pharmacist. Regarding your patient Mr. Jones with HFrEF, the plan is requiring a trial of an SGLT2 inhibitor before approving Entresto. I’ve reviewed his chart and see no contraindications. Would you like me to facilitate a prescription for Jardiance to meet the step therapy requirement?” Wasting time with basic details they assume you already know. Don’t ask them to spell the drug name. Get straight to the clinical problem and your proposed solution.
Hospitalist / Resident Physician Managing multiple acute patients. Often less familiar with a patient’s long-term history. Focused on inpatient stability and discharge planning. Frame your request in the context of their immediate goals. “Dr. Chen, this is the PA pharmacist. I see you’ve ordered Eliquis for Ms. Davis for discharge. Her outpatient plan doesn’t cover it without a PA, which could delay discharge. Xarelto is on her formulary and would be a smooth transition. Can we switch to that to avoid any delays?” Focusing on long-term outpatient issues that are not relevant to the immediate goal of a safe and timely hospital discharge.
Nurse Practitioner (NP) / Physician Assistant (PA) Often have deep, long-term relationships with their patients. May have more time and willingness to discuss alternatives. Collaborative by nature. Adopt a partnership tone. “Hi Sarah, it’s [Name] the pharmacist. I’m working on the Trulicity PA for Mr. Williams. I see the plan wants a trial of metformin first, but I also see in your notes that he has a CrCl of 40. I think we can make a strong case for medical necessity to bypass the step. Can you confirm the CrCl and that you agree with this approach?” Being overly formal or hierarchical. Treat them as the respected clinical colleagues they are. Acknowledge their expertise and deep patient knowledge.

19.1.3 The Framework: Mastering SBAR for Clinical Communication

In the high-stakes world of healthcare, there is no room for ambiguity. Communication must be structured, predictable, and clear. The most widely adopted and effective framework for this is SBAR, which stands for Situation, Background, Assessment, and Recommendation. You may have heard of this in other contexts, but for a CPAP, it is not just a tool—it is your creed. Every single phone call you make to a prescriber should be mentally structured around this framework. It forces you to be concise, to present the most relevant information first, and to always have a clear, actionable “ask.” It is the ultimate sign of respect for the prescriber’s time.

Visualizing the SBAR Workflow

S
Situation

A concise statement of the problem. What is happening right now?

  • State your name, your role, and who you are calling about.
  • Clearly state the immediate issue.
B
Background

Brief, relevant clinical context. What led up to this situation?

  • Provide the patient’s diagnosis.
  • Mention pertinent medical history.
  • State the specific payer requirement.
A
Assessment

Your professional conclusion. What do you think the problem is?

  • State your clinical evaluation of the situation.
  • Identify the specific barrier to approval.
  • Outline the potential options.
R
Recommendation

Your specific, actionable request. What do you need the prescriber to do?

  • Propose a clear course of action.
  • Make it as easy as possible for them to agree (e.g., “Can I send over a prescription for you to sign?”).

SBAR in Action: Masterclass Scripts

Let’s translate the theory of SBAR into the practical reality of your daily work. Here are detailed scripts for common PA scenarios, demonstrating how to structure the conversation for maximum clarity and efficiency.

PA Scenario Deconstructed SBAR Script
Scenario 1: Step Therapy Required

(S) Situation: “Dr. Evans, this is [Your Name], the pharmacist from the specialty group. I’m calling about your patient, Michael Scott, and his new prescription for Cosentyx. The insurance has issued a prior authorization requirement.”

(B) Background: “Mr. Scott has a diagnosis of psoriatic arthritis. The payer’s policy requires a documented 3-month trial of a TNF inhibitor, like Humira or Enbrel, before they will approve an IL-17 inhibitor like Cosentyx.”

(A) Assessment: “I’ve reviewed his chart and I don’t see a previous trial of a TNF inhibitor documented. It appears we have two options: we can either appeal based on medical necessity if there’s a contraindication to TNF inhibitors, or we can fulfill the step therapy requirement.”

(R) Recommendation: “My recommendation is to proceed with the path of least resistance to get him on therapy quickly. Humira is on formulary and would meet the requirement. Would you like me to send a prescription for Humira to your inbox for signature so we can start the PA for that immediately?“
Scenario 2: Non-Formulary Request

(S) Situation: “Hi Dr. Beesly, this is the pharmacist, [Your Name]. I’m calling about the prescription for Viibryd for your patient, Pam Halpert.”

(B) Background: “Ms. Halpert has major depressive disorder. Her insurance plan does not have Viibryd on their formulary at all, meaning it will not be approved. The formulary alternatives in the same class are Trintellix and Fetzima. She has previously tried two SSRIs, sertraline and escitalopram, with inadequate response.”

(A) Assessment: “Since she has already failed two SSRIs, we have a strong clinical justification for a non-SSRI agent. Trintellix is generally well-tolerated and is a preferred brand on her plan.”

(R) Recommendation: “To avoid a lengthy and likely unsuccessful non-formulary exception process, I recommend we switch to Trintellix. The typical starting dose is 10 mg daily. Can I get your verbal authorization to change the prescription to Trintellix 10 mg daily, #30?“
Scenario 3: Missing Clinical Information

(S) Situation: “Good morning, Dr. Schrute’s office, this is [Your Name], the prior authorization pharmacist calling for Dwight Schrute regarding his Ozempic prescription.”

(B) Background: “Mr. Schrute has type 2 diabetes. His insurance plan requires documentation of his most recent A1c and a documented trial and failure of metformin to approve Ozempic.”

(A) Assessment: “I have the recent labs showing his A1c is 8.9%, which meets that criterion. However, I can’t find documentation in the provided notes of a metformin trial. The PA is currently pending this specific information.”

(R) Recommendation: “To get this approved, I just need a note added to his chart confirming the dates he was on metformin and the reason for discontinuation (e.g., GI intolerance). Could you please update the chart and let me know when it’s ready for me to resubmit? Or, if you prefer, you can fax the relevant note to me at [Number].“
The Anti-SBAR: How to Derail a Conversation

It is just as important to understand what not to do. Here is an example of a poorly structured call for the same Scenario 1 (Step Therapy):

Pharmacist: “Hi, is this Dr. Evans’ office? I’m calling about a PA. The insurance rejected the Cosentyx. It needs a PA.” (Vague opening, no patient name, creates work for the office staff.)

Office: “Okay… for which patient?”

Pharmacist: “Michael Scott. The rejection code is ‘ST’. It says he needs to try something else first. I don’t know what they want.” (Presents the problem without having done any research. Puts the burden of solving the problem on the office.)

Office: “So what do you need from us?”

Pharmacist: “Well, can the doctor just do a peer-to-peer or something? Or maybe you have some notes I can use?” (No clear assessment or recommendation. The “ask” is vague and unhelpful.)

This type of call is inefficient, unprofessional, and damages your credibility. The office staff now views you as someone who creates problems, not someone who solves them. Mastering SBAR is non-negotiable for success.

19.1.4 Channel Mastery: Choosing the Right Communication Method

In the digital age, a phone call is not always the best, or even the preferred, method of communication. As a CPAP, you must become a master of multiple communication channels and know when to deploy each one for maximum impact. Choosing the wrong channel can lead to delays, miscommunications, and frustration. The goal is to integrate seamlessly into the clinical team’s existing workflow.

Communication Channel Best Used For… Strengths Weaknesses & Pitfalls
Synchronous Phone Call
  • Urgent Issues: When a delay could impact immediate patient care (e.g., an antibiotic for a hospital discharge).
  • Complex Clinical Discussions: When you need a back-and-forth dialogue to discuss multiple alternatives or a nuanced clinical scenario.
  • Building Relationships: A direct conversation is often the best way to establish rapport with a new provider or their office.
 Immediate feedback; allows for nuance and real-time problem-solving. Interruptive to the provider’s workflow; no paper trail unless you document it yourself; can be difficult to get the right person on the line.
Secure EHR Message
  • Non-Urgent, Simple Requests: “Dr. Jones, PA for atorvastatin is pending labs. Please route the latest lipid panel to my inbox. Thank you.”
  • Providing Documentation: Attaching the payer’s formulary or clinical policy for the provider’s review.
  • Creating a Clear Paper Trail: The message becomes part of the patient’s permanent medical record, documenting your recommendation and the provider’s response.
 Asynchronous (respects provider’s time); creates a formal record; allows for attachments. Can be easily missed in a flooded inbox; not suitable for urgent matters; tone can be misinterpreted in writing.
Fax Communication
  • Formal Information Requests: Sending a standardized form to request specific chart notes or lab values.
  • Communicating with Less Technologically Integrated Offices: Fax remains a surprisingly common and reliable method in some parts of the healthcare system.
  • Submitting PAs to certain plans that still operate via fax.
 Provides a timestamped record of transmission; widely available. Can be lost or misplaced in a busy office; not secure for highly sensitive information; slow; no guarantee the right person will see it.
Email (with caution)
  • General, NON-PHI Communication: “To the staff at ABC Cardiology, here is the updated PA request form for XYZ Insurance for your reference.”
  • Coordinating with industry representatives or other non-clinical partners.
 Universally used; good for sending general information to a group. NEVER to be used for transmitting Patient Health Information (PHI) unless it is a fully encrypted, HIPAA-compliant email system. A standard Gmail or Outlook account is not compliant and using it for PHI is a major privacy violation.
Playbook: Creating a Communication Preference Profile

One of the hallmarks of an expert CPAP is learning the specific workflows of your key collaborators. For your highest-volume prescribers, consider creating a simple “Communication Preference Profile” in your own notes. This small investment of time pays huge dividends in efficiency.

Example Profile: Dr. Angela Martin, Dunder Mifflin Cardiology

  • Primary Contact: Her MA, Oscar. He is very knowledgeable and can answer most clinical questions.
  • Best Channel for Requests: EHR message. Dr. Martin reviews her inbox between 4 PM and 5 PM daily.
  • Urgent Issues: Call the main line and ask Oscar to page her. Use only for true emergencies.
  • PA Workflow: They prefer to handle formulary switches themselves. Your role is to identify the non-formulary drug and clearly present the formulary alternatives via EHR message. They will send the new Rx.
  • Notes: Very data-driven. Always attach the payer policy to your message to support your recommendation.

By knowing this, you can tailor your communication perfectly. You won’t frustrate Dr. Martin with a non-urgent phone call in the middle of her clinic, and you will provide Oscar with exactly the information he needs, in the format he prefers. This is how you become an invaluable part of their team.