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February 24, 2021Automatic Refills: Are They Really That Great?
February 23, 2021 -
An automatic refill sounds great on the surface. Members can make sure they don’t run out of medication by authorizing their pharmacy to fill their prescription(s) at regular intervals. There’s even a perception that automatic refills help promote adherence to medication regimens by making sure members have a constant supply.
The unfortunate truth is, automatic refills aren’t so simple – and in the worst-case scenarios, they aren’t safe. At Global Reach Health, we recognize the perils of refill systems that rely too much on automation and not enough on checking recent patient history. That’s why we promote refill reminders rather than automatic refills through our mail order pharmacy.
- They drive higher medication fill rates, but there is no guarantee that the patient is or should be taking the automatically dispensed medication.
- There are no current industry or governmental safeguards to check that medication dispensed automatically is not meant to be discontinued. If a patient is meant to switch to a different medication or change their dose, the old prescription may still be filled automatically.
- Even if the patient is supposed to continue the therapy, automatic refills are scheduled to be dispensed ahead of the patient’s actual supply, leading to medication stockpiles and prescription drug waste.
Each of these scenarios can create headaches for members, plan sponsors – even prescribers and pharmacies. Members are left with several unappealing options when automatic refills get out of control:
- Go through the headache of telling their retail pharmacy they don’t want the medication, which leaves the pharmacy having filled a prescription that’s effectively been abandoned at the counter. The pharmacy must pay their pharmacist for time in filling and restocking medication that earned no revenue.
- Find a safe way to dispose of a medication they’ve discontinued but were sent anyway because their mail order pharmacy has them on an automatic refill.
- Deal with unexpected charges, if autopay is set up, for a medication they didn’t need but were sent anyway due to automatic refills – after all, pharmacies can’t accept prescription drug returns.
- Try to keep track of several bottles of the same medication if it was dispensed too early or if two different dosage strengths were incorrectly dispensed at once because of automatic refills.
Automatic refills can be especially dangerous if a patient accidentally takes a new prescription meant to replace another without discontinuing the old one, or if unused medications are abused by individuals who shouldn’t have access to them.
For a non-narcotic controlled substance such as Xanax® (alprazolam), which is commonly used to treat anxiety and panic disorders, automatic refills could cause a patient to have an extra two months’ supply of potentially addictive substances on hand. This presents a risk to the patient, and to anyone who may accidentally or intentionally misuse the extra medication.
The cost of automatic refills can add up quickly. The refill is triggered to be released when the patient’s medication supply is assumed to be at 20-25% remaining. This amount varies at both retail and mail order and is set by the PBM. It allows time for the medication to be mailed or for the patient to get to the pharmacy to pick up their order, but the refill occurs regardless of whether the patient actually needs it. For a 30-day fill, automatic refills jump the patient’s supply ahead by seven days a month when they occur at an assumed 25% of the previous fill remaining. This builds up to dispensing an extra two months’ worth of medication over the course of 12 months.
For a commonly used brand medication like Brilinta® (ticagrelor) – a blood thinner used to help prevent stroke, heart attack, or other heart problems – that extra two-month supply can cost an extra $810 per patient per year. The extra expense hits both the plan sponsor and the patient’s pocketbooks.
However, this number only accounts for the cost of direct spending on the medication – not for the expenses that can add up when patient safety is compromised by having excess medication on hand. These include emergency room visits, addiction treatment, and hospitalizations. In the worst-case scenario, having too much medication on hand could be deadly.
Rather than set up automatic refills, patients should think about setting refill reminders. Global Reach Health members can contact your designated pharmacist for refill reminders. This can help patients stay on track without the risks of a medication they don’t need or shouldn’t be taking being automatically dispensed.
Rather than rely on an automated system, patients remain in control and can call in their refills when they’re actually ready for a new supply. They can also more easily coordinate with their doctor or pharmacists if they have any questions that need to be answered before the next fill is dispensed.
We're all busy, and it’s easy to forget about canceling subscriptions of any kind – including for refills of prescription drugs. In the pharmacy arena, the perceived convenience of automatic refills is an unnecessary risk and expense for patients and plan sponsors.