Predictive Refill Programs

I have never been a fan of the predictive refill programs that have taken over our profession.  Correction: The original concept was nice, but we have, as always, let the programs run away from us and now have to fight to get it right.  My problems are these: No one is happy even if they voluntarily enroll in the program and no one program is perfect.

If we call patients to tell them their refills are ready, they are bothered because they are not out of medication yet.  If we do not call a patient, they are bothered because they ran out and no one told them they were going to run out.

I believe the best fix for these programs is to employ the early refill narcotic patients as mentors.  These patients know the exact hour we can fill each of their narcotic prescriptions and usually call us daily and hourly for weeks up to the due date.  If we could simply embed a narcotic taker with a blood pressure taker, then everyone would know precisely when to pick up their prescriptions.  In fact, I would be willing to bet that the diabetics would become even more compliant with their own daily regimens and actually take/use their medications correctly.

No longer would we have to suffer the ignoramus who comes to our counter after 6pm on Friday and complains that his bottles of insulin are empty and he's been without it for 3 days and he's going to die if we don't just give him Lantus and Humalog right now.  Sorry.  If you're willing to bet your life on the first 3 days, I'm willing to bet your life over the weekend.  Let me introduce you to Mr. Percocets.  He's always prompt when his medication runs out.  He's your new flatmate until you can learn to accept personal responsibility for your own health and wellness.

The other issue with these programs is the amount of work involved. I actually believe we had fewer customer complaints prior to implementing these programs.  Under the early refill system, we fill prescriptions we're not even sure they're still taking.  Not only that, but the entire concept is based on strict patient compliance.  It assumes they are taking the medication exactly as prescribed, not missing doses, and keeping appointments.  We all know what happens next: Our computer calls the patient on days 3, 5, 7, 9, 11 (or according to some patients, never) and they don't come in for it.  On the 13th day, per insurance regulations, we put the medication back in stock.  Now we have to label this bottle with a lot # and expiration date because the State Board says we can't dump it back in the stock bottle and then we have to hope we can use it in the next 90 days (Ohio's law).  Then, on day 14 (or mere hours after we pulled the bag, reversed the claim, and returned it to stock) the patient comes in and wants to know why it isn't ready and why they have to wait another 20 minutes when it should have been done last week.  This is usually followed with "I got a call that said I had until yesterday to pick it up. Why isn't it done?"  I guess you ignored the first 4 phone calls you got, huh?  Now we have to put them back in line, pushing back the other people whose prescriptions we should be filling, and do everything for them a second time.  This one person made us do triple work, but we only get paid once.  Never mind the other costs that go into filling the script.  How is this more efficient?

What about the automatic doctor refill requests? Wasn't that part of the original plan too? The refills would pop into our system early, see the patient was out of refills, fax the doctor, the doctor would get back to us, the refill would be filled, the patient would come in having no idea all the work that went on behind the scenes, and walk out, happy and ignorant as a clam. Brilliant! Except it never works that way. The patient wanted it somewhere else, switched to mail order, hasn't been to the doctor in over two years so they deny the refill, then the patient's phone number is disconnected.

(Full disclosure: The only reason I have to favor the refill system is for out-of-stock or special order drugs.  I don't have to keep these items in stock or I get at least a day's notice I need to order extra of something just for you.)

It's become a stupid, busywork generating system that promised to save us time but seems to only create  more work. We even have to dedicate 1-2 tech hours a day solely on dealing with these old refills. I understand the need to generate more prescriptions as much as any pharmacist today, however, how much time are we really saving?