I don't even know how to phrase these questions so I'm just going to explain as much context as possible and ask later. I started floating for a small network of independent pharmacies after being full time at the three letter. We use PrimeRx as our EMR and as a result of some quirks with the software, it has led some of these stores to do some... weird things when it comes to billing for "audit" purposes. To give examples....

For regular prescriptions, if the insurance pays for a lower quantity than what is prescribed, at the 3 letter we keep the "ordered" quantity and the number of refills the same as what the doctor prescribed and just changed the dispense quantity. Instead, my independent changes the ordered quantity to whatever the insurance pays, and then change the number of refills to match the total quantity. i.e.

If insurance only pays #30 days... Original Rx from MD:

Atorvastatin 80 mg 1 PO QD Ordered #90 REFILLS: 2 Dispense: #30

Entered Rx:

Atorvastatin 80mg 1 PO QD Ordered #30 Refills: 8 Dispense #30

This always bugs me because why change the prescription based on how the patient is paying? Just changed the dispensed quantity....

Also, for brand/generic interchange, they're so scared of an audit that if the insurance decides to start paying for generic after having only paid brand (DAW 9), they would rather discontinue a valid script with refills and obtain another prescription rather than just fill the same script but for generic. This just seems like such a waste of doctor time since why would a doctor have to rewrite a script based on formulary changes if they didn't indicate DAW?

Am I crazy for asking these questions or are these just weird behaviors? Literally only one store in this network does this and I feel like changing the script that much puts them MORE at risk of losing money from an audit than not