Introduced by: Brian Bachelder, MD, FAAFP
Whereas, most pharmacies send prescribers an automatic refill request when the last refill is dispensed to a patient; and
Whereas, automatic refill requests create a significant amount of administrative work that must be done by the physician; and
Whereas, automatic refill requests are often received too early or are inappropriate/inaccurate, which can lead to medical errors and confusion for patients; and
Whereas, pharmacies do not currently have the ability to turn off the automated requests to a specific prescriber when asked to do so; now, therefore, be it
Resolved, that the Ohio AFP create as policy that physicians be able to opt out of automated refill requests from pharmacies;
Resolved, that the Ohio AFP submit a similar resolution to the American Academy of Family Physicians (AAFP) with the addition of requesting that the AAFP work with pharmacies to comply with this request;
And therefore be it further Resolved, that the Ohio AFP forward a similar resolution to the Ohio State Medical Association via the OSMA Delegate for their adoption.
I agree
Agree – automated refill requests for discontinued prescriptions can be dangerous. better solution might be to allow pharmacies to accept “cancel” requests and “replace” requests so that only active prescriptions would be sent to prescribers for refills.
Absolutely agree. The time it takes to call the pt to see if they really need the refill or not and usually they don’t is a waste of time for my staff.
I agree. More and more, computer programmers are working to structure everything that physicians do. This development comes from the false assumption by non-patients and non-physicians that medical care can be made more safe, effective, and efficient if it is fashioned on a factory, mass-production module. This elimination of the physician-patient relationship, which should unique for each interaction, devalues that relationship and compromises the quality of its care.
I fully support Dr. Bachelder’s resolution. Half of all pharmacy refill requests for my patients are inappropriate. Our 10 physician office receives about 200 refill requests from pharmacies every day. Often, a new refill was ordered the week before, but an automated request is sent based on the old rx number. Also see other examples sited by Dr. Bachelder and Heng. This is a patient safety issue and unnecessary administrative burden for our physicians. Our organization tried to work with pharmacies and PBMs without success.
I agree with the concept and I think it is an important one. I think that sometimes these issues can be better communicated by using the most specific language. To me a refill is always automatic. If the physician thinks the use of a medication should be reevaluated after the passage of a year, she/he would write for a 90 day supply with three refills. After that, the prescription should be renewed, not refilled. Renewal implies that the physician has considered the drug again, is it still appropriate, is it the right dose? Is it the best drug? Is it the most cost-effective drug? When renewal is due it implies that a visit is due to consider that particular drug . If there is a scheduling issue, a brief extension such as 30 days would be appropriate.So II think if we use the words refill, renewal, and extension in this manner, the logic behind the practice is exposed. Furthermore, it is often more work to discontinue a medication than it is to start one. Since one of our goals should be to make sure our patients are using the fewest drugs,in other words no unnecessary medication, some time between the doctor and the patient must be allocated. If a doctor has allowed Enough refills for 360 days and in the middle of that time, the patient changes pharmacy, transferring the refills should be accomplished with minimum physician involvement. When a renewal is required, the doctor should not have to say the patient needs to be seen, it should be understood.
I agree – relevant reasons already cited above. Automated refills can lead to significant errors with discontinued medications and dose adjustments. Thank you!
I agree.
Agree wholeheartedly. Due to safety concerns, we stopped accepting refill requests directly from pharmacies years ago. They were often for meds which had been changed or discontinued, but the pharmacies didn’t know and kept sending requests. Their business is to sell meds, so no surprise they’d be in no hurry to stop sending automated requests.
We let all of our pts (and the pharmacies) know that the pt needs to contact us to request renewals. We now ignore the faxed requests from pharmacies.
Yes. This is a great resolution. We need to be careful about what we are automating in medicine. Many times, patients do not need a refill. And it’s better for the patient-physician communication if the patient requests the refill themselves. This provides valuable knowledge about how the patient has been taking the medication.
I agree. This would decrease the chance of errors