Provider Notice issued 04/24/13

Auto Refills

Effective May 1, 2013, the use of automatic refills by a pharmacy will no longer be allowed. All prescription refills must be initiated by a request from the prescriber, participant, or other person acting as an agent of the participant, e.g., a family member. The possession of a prescription with remaining refills authorized does not, in itself, constitute a request to refill the prescription. The department will not reimburse a pharmacy for any prescription claim that has been filled using an auto refill process. Any claim for a prescription filled without a request from the prescriber, participant, or agent of the participant will be subject to recovery. Claims for prescriptions that have been filled using auto refill and inadvertently billed to the department must be reversed by the pharmacy.

The practice of automatically refilling prescriptions substantially increases the risk of a medication being automatically dispensed even after the prescriber had intended that it be discontinued. Through the Four Prescription Policy medication reviews, Department staff have found that this occurs regularly with our participants, often when the prescriber had intended a dosing change. Patients may not be aware that prescribers do not automatically notify their pharmacy when they intend to discontinue a medication. This results in serious occurrences of polypharmacy and drug/drug interactions. In addition, the practice automatically generates a call to the prescriber for refills when there are zero refills left. This can cause confusion for the prescriber and the patient as to why additional refills are needed when the prescriber intended that the medication previously be discontinued.

Questions regarding this notice should be directed to the Bureau of Pharmacy Services at 1-877-782-5565, Option7.

Theresa A. Eagleson, Administrator

Division of Medical Programs