Refill Dilemmas

Peter Forster About GPS, GPS Update Leave a Comment

“Why do you only give me a month’s supply of medication when you approve refills?”

This is a pretty common question and I thought a blog post might be a good way of discussing the issues.

After all a refill is a quick thing to handle, right? You call a number and press a few numbers, go onto your iPhone and scan the barcode on your prescription, or setup automatic refills.

All of this convenience is great, but we still have to make sure that we review every request. Is this a patient with a future appointment? Has the prescription changed in some way? Is the refill being requested early (suggesting that perhaps the patient has been taking the medicine in a different way than our prescription)?

Pharmacies have gotten increasingly busy and this is sometimes had an impact on the quality of the work that they do. In the last couple of years we have noticed an increase in the number of times that a pharmacy will request a refill for medication that has an existing prescription with a different set of instructions. For example, a pharmacy might request a refill for venlafaxine XR 75 mg one per day, when for the last two months of patient has been getting venlafaxine XR 75 mg two per day. It doesn’t happen often, but at least a couple of times we refilled the prescription (since it was for the right medication, even though the label was not correct) and the patient decided that we thought they should change how they were taking the medicine.

The problem with refills is that there is no communication possible. I can’t ask if you understand that you are asking for a refill of an old prescription. You can’t ask me if the label is different. I can’t find out if you are having side effects, or have misunderstood how you should be taking the medicine, etcetera, etcetera.

And the number of refill requests we’ve been getting has been increasing. In fact several of our colleagues in the psychiatric community in San Francisco have recently stopped refilling prescriptions between appointments because the volume of the work has gotten to be such a burden and they feel that they’re not able to do a good job of assessing each request.

So with more refill requests coming in, and more inappropriate refill requests, the process of review has gotten more complicated and yet the system itself does not allow ready communication with the patient. When we get a refill request we have essentially five options which boil down to either approve it or don’t approve it, and there is no opportunity to ask for more information.

In fact, a refill often takes more time than writing prescriptions when we see each other, precisely because asking questions can stretch the process out for hours.

“Why is this refill request coming through early? “

“We just gave a prescription for the same medication a week ago.”

“You said you were going to stop the medicine and switch to a different one.”

These are all questions that have come up when we have been reviewing refills this past week.

Some things are important enough that taking extra care is worthwhile even in the midst of a very hectic life. This past couple of days I received two email requests to “refill all my prescriptions” from reliable people who got irritated with me when I emailed back for more information.  “Don’t I have a record of what they’re taking, don’t I know this, why am I emailing them?”

In both cases it turned out that my concerns were justified.  Both of these people were actually, for slightly different reasons, taking different doses of their medications than what I had prescribed (and therefore different from what  my records indicated). That was the reason why, when I checked those records, it looked as though they should not be getting the refills that they were asking for.

This seems to be happening more often as automatic refill programs in various pharmacy computers generate refill requests that don’t require any thought on the part of anyone (pharmacy, patient, etcetera).

We get more requests that don’t appear to be appropriate and we have to spend more and more time making sure that these automated refill requests are not endangering patients.

Here are some ways you can make sure that the process of getting a refill is a smooth as possible…

  1. If you want a refill of an existing prescription and there are no additional refills on that prescription you can request that the pharmacy contact our office electronically to request an additional refill be authorized.
  2. We will only authorize one additional refill and we will strive to make sure that we talk about medications and write for all needed prescriptions at our next appointment.
  3. If for any reason the refill appears unnecessary or untimely or there is any other question about the prescription we will deny it with a request that you contact the office.
  4. If you get a denial, the first thing that you should do is contact your pharmacy to make sure that they do not have another prescription for the same medication that does have additional refills. (Elsewhere we have talked about the peculiar fact that pharmacies do not consolidate all of your prescriptions for medication X into one set of refills but rather store them by prescription number so you may request a refill on prescription number ZQR for a medication and it may be denied, but there may well be another prescription number ADJ that has additional refills and the only way of finding this out is talking to one of the pharmacy staff and having them look through their computers).
  5. In general if you were requesting a refill and there is anything unusual about the request (you are about to run out, you are requesting an early refill because you will be traveling, etcetera) I strongly encourage you to use the resources available in the online office section of this website.  Click on online office, current patient, medication issues and you can fill in the information about the medication and dose and what you think you’re supposed to be taking of that medication and the name of the pharmacy and it will allow me to fill a prescription much more rapidly and will minimize the need for a phone conversation or other interaction.

If you use the online office for a refill request I will not charge for special handling of the request.

If you don’t use the form for a request and a refill requires an unusual amount of time on my part to sort through what is going on I will charge for my time.

  • Several of the “routine refill request” this past week each took a half an hour to sort out.  And since I get many refill request in a day it doesn’t take too many complicated refill requests to make it impossible for me to have time to see patients.

The form is pretty simple and I’m always striving to make it easier. All of the information I need to know is on it and so it should be your “go to” place for any medication question or urgent or otherwise complicated refill request.