Auto Refill Programs Under Scrutiny

       Chances are if you work for a larger retail pharmacy chain, your employer has some sort of auto refill service available for your pharmacy customers.  But those services are now being investigated under concerns that patients are having prescriptions filled they didn’t want or need. 

        The idea is simple really.  Patients have maintenance medications they need filled on a regular basis.  These patients may not want the hassle of having to request a refill for the same prescriptions time after time. 

        So out of convenience, many large retail pharmacy chains (and some smaller ones) offer some sort of auto refill service.  The programs, usually requiring patients to opt-into the service, will automatically refill a maintenance medication for a patient at some set interval.

        So what is wrong with such a program?  Well there are now concerns that patients are being enrolled in these programs without their consent, prescriptions are being filled that weren’t requested, and there are even questions of potential Medicare fraud related to these services.  

         The LA Times reported that CVS was investigated earlier this year for filling prescriptions and billing insurance companies for medications without patient approval.  Now, questions surrounding other auto refill programs at other large retail pharmacy chains are emerging. 

           Concerns are being raised that some retail pharmacy chains may have quota systems in place to put pressure on store level pharmacists to enroll as many patients as possible.  And while the companies have publicly denied it, pharmacists are reporting that their compensation may be at least partly tied to meeting these goals or quotas. 

            The result is that patients may be enrolled in such programs without their consent.  And this could lead to prescriptions being filled for patients that weren’t needed in the first place. 

             Have these drugstore chains become too aggressive with their auto refill programs?  Are these companies at risk of committing insurance fraud by billing for un-necessary prescription claims?  These are questions federal and several state investigators are now looking to find answers. 

             I will say that my company, like several others, does in fact track auto refill percentages and there is pressure placed on pharmacists to boost auto refill enrollment numbers.  And because auto refill programs are commonplace now, I could see where it would be a focal point for management teams at several large retail pharmacy chains. 

           I don’t personally have a problem with auto refill programs as long as it is a program patients must opt in and the chains don’t use enrollment numbers for performance comparisons.  Unfortunately, some chains apparently have used auto refill program enrollment numbers for the basis of evaluating, ranking, and rewarding stores and employees.

            I’m glad there are investigations into auto refill programs.  The problem is what can investigators do?  A fine doesn’t seem to faze the larger pharmacy chains.   What will fining a company the size of CVS really do to curb behavior or change corporate culture?  It would have to be a meaningful amount relative to the company’s earnings to even have a chance to be effective.

            I’m glad this story is getting out to the masses because it demonstrates the pressure large pharmacy chains place on meeting metric goals.  As pharmacies are pushed toward meeting goals such as higher auto refill percentages, what is lost is the need to maintain filling accuracy and prevent needless mistakes. 

            Does your employer put pressure on store level staff to boost auto refill enrollment?  Is there any level of bonus or compensation that is tied to meeting a quota or enrollment level?  Do patients get enrolled without their consent?  I’m afraid too many of us would answer yes to those questions. 

The Redheaded Pharmacist

4 Comments to “Auto Refill Programs Under Scrutiny”

  1. By BCMIGAL, October 23, 2012 @ 12:44 pm

    I cannot think of any company that does not offer some easy/ready/auto fill or whatever horse it’s called. It also needs to be pointed out that when a claim is successfully transmitted, the money is not immediately dumped into company coffers. The claims are usually “batched” and then submitted by a “third party” department within a specific billing period. Our pharmacy reverses claims for meds that have waited for pt pickup on the 14th day. This is a daily activity. In addition, “waiting” prescriptions are rescanned on a monthly basis and compared to what the “system” expects in payment. I think the article is misleading in that respect.
    That being said, there are TWENTY targets/goals that not only determine a raise or bonus but also the level and intensity of threats and harassment. None of the goals mention accuracy or patient care. To deny that there are quotas is just a lie. Woe to those who cannot or refuse to keep up. They are often spoke of in the past tense.

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  2. By Pharmaciststeve, October 23, 2012 @ 8:59 pm

    From a time/inventory management perspective.. auto refills make sense.. but.. only if the patient is on board with the program… Who believes that calling a person once a month to remind they that they SHOULD HAVE taken all their medication by now… will increase compliance.

    My wife takes a bunch of medications and I opt not to do auto refills.. because I would be having to run to the pharmacy probably twice a week… as they come due..

    She is pretty compliant.. but not perfect… neither am I for that matter with my own meds..

    All Rxs are filled for 90 days and I have a reminder in my IPhone to check her meds every 90 days. She always has a surplus… the pharmacy always has time to order in inventory if necessary.. and I end up making only one trip or include it in running other errands.

    because I understand how the system works… I make the system work for both me and the Rx dept.

    If we educate/train our pts how to use the system to work for them.. would it work out better for all involved?

    converting/educating one appropriate pt at a time… could make a significant dent in how our work environment interacts with all of the staff and the patients?

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  3. By Wrong Aid, October 24, 2012 @ 5:54 pm

    “If we educate/train our pts how to use the system to work for them.. would it work out better for all involved?”

    No no no! That IS the problem with the whole idea. We are signing up people who can NEVER understand auto fill. For my location, if we signed up every single person capable of understanding anything at all, much less a computer based auto fill system, our percentage would be maybe at the very most 10%. Rite Aid has a 40% quota. It’s a god damned quota no matter what they say. We fill unwanted, not needed, and prescriber discontinued meds every single day. These people pick up anything and everything. No idea what it is. All they know is someone called and said they have something ready. I’ve been saying for years that there’s no way auto fill should be legal. It’s dangerous and its insurance fraud. I hope this scares my company into backing off this metric at least.

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  4. By Kevin, October 26, 2012 @ 8:35 am

    Obviously metrics have become a huge part of our business these days, and does not do anything to improve patient care. That being said, I don’t agree with autofill programs being a bad thing. I feel like it helps to reduce the burden annd pressure of people waiting at the pharmacy for a refill they could have called in hours or days before coming to pick it up. The only problem with the insurance billing issue is if meds that aren’t picked up aren’t returned and credited back to the insurance company, which is just as much wrong if it was a non-autofill Rx.

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