Auto Refill Programs Not The Whole Answer

       We all know why the large retail pharmacy chains like auto refill systems.  But do these programs really help the chains?  Do they even help patients? 

       Chains love auto refill programs about as much as they like metrics.  In fact, auto refill percentages is one of the statistics that chains love to track. 

       Does such a program help patients remember to pick up or take maintenance medications?  Do these programs help the drugstore? 

        Retail pharmacies are in quite a dilemma.  Promotion after promotion they attempt is simply duplicated by competitors.  Pharmacies want to find sources of consistent and predictable prescription volumes.  They also want to differentiate themselves from the rest of the pack.

        Retail pharmacies operate in an environment where the power has shifted away from healthcare providers towards the insurance industry.  Pharmacies are being forced into looking for any way possible to gain and retain steady prescription business to offset lower margins and poor reimbursement rates.  They also want to try and prevent as many patients as possible from transferring to other pharmacies. 

         Enter the auto refill program.  The idea is to make it convenient for patients by automatically filling maintenance medications for patients at a set interval.  Patients only have to come pick up their refills on a set schedule.  The pharmacy gets a steady source of revenue and everyone is theoretically happy.  Patients no longer have to request the same refills month after month.  It all sounds great in theory. 

       There is one little problem.  It’s not that simple.  Patients forget to pick up their medications.  Allogations surface that companies enroll patients without their consent.  Sometimes patients end up with too much of a medication because it’s constantly being filled too early.  Implementation hasn’t exactly matched expectations for these auto refill programs. 

       Pharmacies are desperate to prevent or minimize losing pharmacy customers to either a competitor down the street or a mail-order pharmacy elsewhere.  And in these desperate times to maintain prescription business, ideas such as auto refill programs are born. 

       If the major pharmacy chains really want to stabilize prescription volume and revenue, they’d better start fighting pharmacy benefit managers (PBMs) and the insurance industry.  Attempting to minimize mandatory mail-order plans or fighting for higher reimbursement rates and dispensing fees will go a lot further to help community pharmacy than any auto refill program. 

       Auto refills can’t be your only answer in the search for steady revenue and profits.  If anything, these programs create more work, more waste, and more confusion among your loyal customer base.  And do they even do anything to help patient compliance with maintenance medications?  At least a compliance boost would justify the programs.

       There are customers that use and enjoy auto refill services.  And for them, it’s a nice touch that their local pharmacy provides. 

       Feel free to keep auto refill programs available for all those patients that do use and appreciate them.  Just don’t think these programs are something they’re not.  They will not be the answer to mandatory mail order plans, preferred provider networks, and other insurance developments that limit patient choices and hinder an open market in the community pharmacy setting. 

       Don’t expect auto refills to be the whole answer to all of community pharmacy’s growth problems.  If this business was that simple, we would have created auto refill programs a long time ago. 

The Redheaded Pharmacist

2 Comments to “Auto Refill Programs Not The Whole Answer”

  1. By Pharmaciststeve, November 29, 2012 @ 11:04 am

    Putting on my MBA hat.. I think that much of the reason for the push for auto refills has to do with being able to keep inventory levels lower, not having to staff for the ebb and flow of demand for refills that is typical of retail, and maybe lessen the chance of pissing off a pt because their is no refills, the drug is out of stock and the pt is out of meds.

    Personally, I don’t use auto-refills from nothing more than from a practical standpoint… a recent personal experience shows how things can go wrong with auto fill.. I recently had my annual physical and my PCP changed the strength on a couple of my Rxs… Two Rxs… filled on the same day…

    well, this practice is not real good on calling back on refill requests… so I always order my refills 7 days ahead.. In this particular case… one had refills and one did not… I requested both to be refilled at the same time… it took the PCP 4 days (over a weekend) to get around to authorizing a refill… Now I have two Rxs … that started on the same date.. now has refills date – four days apart… repeating this a couple of more times and I would have ended up making numerous trips to the pharmacy to pick these up.

    take a pt with 6-8 meds and you can see how they could be getting calls … a couple of times a week to pick up meds. The insurance company doesn’t care how many times a month that I have to travel to the pharmacy and the cost involved…. but I do… and I suspect that many pts do likewise


  2. By The Redheaded Pharmacist, December 7, 2012 @ 11:40 pm

    (The following comment was written by a reader. My spam filter blocked it by mistake so I agreed to post it for them. If anyone ever has a problem posting legitimate non-spam comments on my site please e-mail me and I will gladly post your comments for you.)

    From RPh on Vacation:

    There are pros and cons to automatic refills. From the pharmacy owner point of view, they seem to make for good business because of the steady volume and revenue. They can be used to spread out labor over the day so that staff are not idle on nights or weekends. But if you have employees filling Rxs from open to close, when do they have time to maintain neat shelves, accurate inventory, complete reports and filing, or even clean the counters, floor and trash?

    From the patient/customer point of view, they are great if they work as planned: Rx is filled before they run out, they receive phone call and come pick up Rx. This rarely works like clockwork. The systems either refill Rxs too soon or too late for the customer’s liking. If prescribers must be called for refills or stock has to be ordered to complete the fill, the cycle gets off and customers get annoyed when they have to come to the pharmacy multiple times.

    But if you ask me, the biggest problem with auto fills is that they decrease something that pharmacy is supposed to be promoting: patient engagement in their own health care and medications. Patients now regularly tell me they don’t know what medications they take or why they take them. They just take whatever drugs the pharmacy calls and tells them to pick up. If the prescriber calls in a new strength of their medication, many patients continue taking BOTH strengths. The automatic filling system continues filling both strengths and if you ask them which one they are supposed to be taking, they don’t know (sometimes the prescriber doesn’t know and both continue to have refills authorized). If customers ignore the phone calls or for some reason don’t pick up the Rx that is ready, do they forget to ever call it in and take it again? Do they think the pharmacy stopped filling it and they never have to take it again? Patients have told me that the pharmacy stopped filling their medication automatically, so they didn’t have to take it anymore. As much as patients trust their pharmacists, this is not the way we want people to understand and manage their medications.

    This lack of patient engagement in their own medications negatively impacts the pharmacy in ways the owners may not realize. Rxs are returned to stock in greater numbers, wasting time and labor. Patients return many medications after purchase because they are no longer taking them and they never requested them. The auto fill processed the refill and they picked it up, signed for it and purchased it, but they didn’t want it and they want their money back. More time and money wasted. When the phone call comes from the pharmacy that the Rx is ready, the patient often has to return the call and ask which Rx is ready because they don’t know what is being filled. More time and labor being wasted.

    Perhaps the day will come when pharmacy owners look at the hidden costs and decide automatic filling programs are not worth it and maybe they will stop requiring quotas and promoting the service to every customer.


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