When you or a loved one gets a new prescription, understanding how to take it isn’t just helpful-it’s life-saving. But if English isn’t your first language, that understanding can slip through the cracks. Medication errors among people with limited English proficiency (LEP) happen three times more often than among English speakers, according to a 2012 study from UC San Francisco. The fix isn’t complicated: you have a legal right to a professional interpreter during medication counseling. No one should be left guessing whether to take a pill with food, at night, or in halves.
Know Your Rights Before You Walk In
You don’t need to ask nicely. You don’t need to apologize. Under Section 1557 of the Affordable Care Act, any pharmacy or healthcare provider that receives federal funding must provide free language assistance services-including interpreters-for medication counseling. This rule applies whether you’re at a big chain like CVS or a small local pharmacy. You’re not asking for a favor. You’re exercising a right.How to Ask for an Interpreter
The key is to be direct. Don’t say, “Can someone help me?” or “Is there someone who speaks [language]?” Say: “I need a professional interpreter for my medication counseling.” That phrase triggers the legal obligation. Pharmacists are trained to respond to this request. If they hesitate, ask to speak to the manager. They are required to provide the service at no cost to you.What Kind of Interpreter Should You Get?
Not all interpreters are created equal. There are three main ways to get help:- Phone interpreting - Quick and cheap. Services like RxTran connect you in under 30 seconds most of the time. But if you’re elderly or have hearing issues, phone-only can be confusing. One study found 32% of older LEP patients struggled with phone-only counseling.
- Video interpreting - Best balance of cost and clarity. You can see the interpreter’s facial expressions and gestures, which helps with tone and urgency. About 65% of healthcare facilities use this method now. It’s usually $3-$5 per minute.
- On-site interpreter - The gold standard. Especially for complex meds like blood thinners, insulin, or psychiatric drugs. Pharmacists say patients understand 78% better when an interpreter is in the room. But these are harder to find outside big cities.
Never accept a family member, child, or untrained staff member as your interpreter. A 2021 study in JAMA Pediatrics found using family members increases the risk of serious medication errors by 49%. Even if your cousin speaks both languages, they likely don’t know what “take on an empty stomach” means in medical terms-or how to say “avoid grapefruit juice” in your language.
What If the Pharmacy Doesn’t Have an Interpreter?
If the pharmacy says they don’t have one, ask them to call a service. Most pharmacies have contracts with companies like RxTran, LanguageLine, or CyraCom. These services are available 24/7. If they refuse, tell them you know your rights under federal law. You can also ask for written translated materials. In California, pharmacies must have printed directions in Spanish, Chinese, Korean, Russian, and Vietnamese. These are called SIGs (Directions for Patients), and they’re standardized across the state. Other states are catching up.
What’s Included in Medication Counseling?
A real interpreter doesn’t just translate words. They help explain:- When and how often to take the medication
- What foods or drinks to avoid
- Possible side effects and what to do if they happen
- What to do if you miss a dose
- Why this medication was prescribed for you
Pharmacists are supposed to cover all of this. With an interpreter, they can. Without one, they often skip the hard parts. That’s why you need to insist.
What About Written Translations?
Written materials matter too. Prescription labels should have clear instructions in your language. The RxTran system lets pharmacies print pre-translated warning labels directly onto your bottle. You should get a printed copy of your medication instructions in your language. If you don’t, ask for it. Many pharmacies have these sheets in their back office but won’t offer them unless you ask.How to Spot a Qualified Interpreter
A professional medical interpreter has:- At least 40 hours of training in medical terminology
- Certification from a recognized body like the National Board of Certification for Medical Interpreters
- Knowledge of confidentiality rules under HIPAA and the ACA
Don’t be fooled by staff who say, “I speak Spanish.” A 2022 University of Arizona study found only 12% of self-identified bilingual pharmacy workers passed a basic medical terminology test. That’s why federal rules require trained interpreters-not just bilingual employees.
What to Do If You’re Refused
If a pharmacy refuses to provide an interpreter, document everything: date, time, name of staff, what was said. Then file a complaint. You can report violations to the U.S. Department of Health and Human Services’ Office for Civil Rights (OCR). Since 2016, they’ve settled 47 cases involving language access in healthcare-including a $1.2 million fine against a national pharmacy chain in 2022. Your complaint can help others too.Special Cases: Children, Elderly, and Rural Areas
If you’re caring for a child, the rules are even stronger. As of November 2023, CMS increased reimbursement for interpreter services for children in Medicaid and CHIP from 50% to 75%. That means pharmacies are more likely to have services ready for kids.For elderly patients, video interpreting is often better than phone. Visual cues help with memory and comprehension. If your parent has dementia or hearing loss, insist on video or in-person help.
In rural areas, on-site interpreters are rare. But phone and video services still work. If your pharmacy claims they can’t connect, ask for the name of their language service provider. Then call that company directly. Most have customer lines you can reach from anywhere.
What’s Changing in 2025?
New rules took effect January 1, 2025: AI translation tools can no longer be used for prescription labels or medication instructions unless reviewed by a human. That means no more Google Translate printouts. Pharmacies must use certified translations.California is adding new languages-Tagalog and Arabic-to its standardized SIG system. Other states are watching. The number of LEP patients in the U.S. is expected to hit 28.6 million by 2030. That means more pressure on pharmacies to get this right.
Final Tip: Bring a Notebook
Even with an interpreter, take notes. Write down:- What the medicine is for
- How many pills to take
- When to take them
- What to avoid
- Who to call if something goes wrong
Ask the interpreter to repeat it back to you. If they can’t, ask for someone else. This isn’t just about understanding-it’s about safety.
Can I be charged for a translator during medication counseling?
No. Federal law prohibits pharmacies from charging patients for interpreter services during medication counseling. This includes phone, video, or in-person interpreters. If a pharmacy tries to charge you, you have the right to refuse and report them to the Office for Civil Rights.
What if I don’t speak any of the languages the pharmacy has translations for?
Pharmacies are required to provide interpreters for any language, not just the ones with printed materials. Even if your language isn’t listed (like Somali, Bengali, or Farsi), they must connect you to a qualified interpreter via phone or video. Don’t accept a translation in a different language-ask for your own.
Can I use a friend or family member who speaks both languages?
You can, but it’s risky. Studies show using untrained interpreters increases medication errors by nearly 50%. Family members may not know medical terms, avoid difficult topics, or unintentionally soften warnings. For safety, insist on a professional interpreter, especially for high-risk medications like blood thinners, insulin, or chemotherapy drugs.
Do I need to request an interpreter every time I pick up a new prescription?
Yes. Even if you used an interpreter before, each new prescription requires a fresh counseling session. Medications change, dosages change, side effects change. Your interpreter should be present for every new drug you’re given. Don’t assume your language need is on file-always ask.
What if I’m not sure if I need an interpreter?
If you’re unsure whether you understand everything about your medication, you need an interpreter. Don’t wait until you have a reaction or make a mistake. It’s better to ask and be safe than to assume you understand and risk harm. Pharmacists are trained to recognize language barriers-you just need to speak up.
14 Comments
Rebekah Cobbson
Just had my mom’s blood pressure script explained to her with a video interpreter last week. She’s 78, hard of hearing, and didn’t understand a word the pharmacist said. The interpreter made her cry-not from sadness, but because she finally felt seen. This isn’t a luxury. It’s basic human dignity.
Audu ikhlas
USA thinks it can fix everything with laws but still cant get people to stop using kids as translators. My cousin in Lagos would never do that. We respect our elders and our language. You people need to stop being lazy and learn English if you wanna live here.
Sonal Guha
32% struggle with phone interpreting 65% use video 78% better with on site 49% higher error rate with family 12% of bilingual staff pass medical test
TiM Vince
I work with refugee families in Chicago. We had a Somali grandmother who thought her diabetes med was candy because the label said 'take one daily'-she didn’t know what 'daily' meant. We got her a video interpreter. She cried. Then she made us tea. That’s the real win here.
gary ysturiz
You have rights. Use them. No shame. No apology. Just say 'I need a professional interpreter' and mean it. Your life matters more than their convenience. And if they push back? Walk out. File a report. They’ll call you back.
Jessica Bnouzalim
OMG YES!!! I begged my pharmacy for a Spanish interpreter for my abuela’s chemo meds and they said 'we have a translator app'... I nearly lost it. They don’t get it. It’s not Google Translate-it’s your life. Please, if you’re reading this: demand a REAL person. Don’t let them gaslight you.
Bryan Wolfe
My uncle got a new heart med last month. The pharmacist tried to use his nephew-16 years old, never taken a biology class. My uncle took the wrong dose and ended up in the ER. After that, we demanded a certified interpreter. They came within 20 minutes. He’s alive today because we didn’t back down. This isn’t optional. It’s survival.
Sumit Sharma
The data is unambiguous. Untrained interpreters introduce systemic risk. Medical terminology requires domain-specific lexicon. The 49% error increase is statistically significant (p<0.01). Pharmacies that default to ad-hoc interpretation violate both clinical ethics and regulatory compliance frameworks under ACA Section 1557. Institutional accountability is non-negotiable.
Jay Powers
My neighbor’s daughter speaks both English and Vietnamese but she’s 12. I told her mom to never use her. Kids shouldn’t be burdened with life-or-death translations. We need more trained interpreters in rural areas. Not just in cities. Everyone deserves to understand their medicine.
Prachi Chauhan
Why do we think language is just about words? It’s about trust. When someone speaks your language and looks you in the eye, you believe them. When a phone voice drones on, you doubt. And doubt kills. The real issue isn’t translation-it’s whether we care enough to make space for people to be understood.
Katherine Carlock
My cousin in Texas got her insulin instructions in Korean from the pharmacy printer. She said it looked like a fortune cookie. She called the number on the sheet and got a live interpreter in 15 seconds. Now she keeps the printout in her wallet. She says it’s her safety net. We should all have one.
Sona Chandra
They think they can just slap a Google Translate label on a bottle and call it good? I had my aunt almost die because they gave her the wrong dosage because the 'translation' said 'take one' but meant 'take one per hour'-and no one caught it. This isn’t a mistake. This is negligence. And someone needs to pay.
Craig Wright
It is a curious phenomenon that American institutions, so eager to enforce linguistic compliance, often neglect the fundamental duty of cultural competence. In the UK, we rely on NHS-approved interpreters, not corporate contracts. The notion that a 30-second phone call substitutes for human understanding is not only inadequate-it is morally bankrupt.
Lelia Battle
I used to think I didn’t need an interpreter because I 'got by.' Then I got my first new prescription after a stroke. I didn’t understand 'take on an empty stomach.' I thought it meant no breakfast. I took it with coffee and my blood pressure spiked. Now I ask every time. It’s not weakness. It’s wisdom.