A few years ago several of the large pharmaceutical chains started offering automatic refills for convenience. On the surface this seems like a great idea for patients, as they no longer need to call the pharmacy for refills. The pharmacy calls the patient when it’s time for the prescription to be picked up, whether it is needed or not.  The pharmacies claim that it improves compliance.

However, there are some issues with this service, which is marketed by one pharmacy chain as “courtesy refills.” Recently I had asked a patient to bring her medications with her on the next visit. Our office does this to help with medication reconciliation to ensure that we know what medicines patients are taking and how they are taking them.

Much to my dismay, the patient had duplicates of several of her bottles of medicine, including a couple which had actually been discontinued. Her brother informed me that she actually had seven bottles of gabapentin at home from one of her other physicians.  When a medication change is made, the computers at the pharmacy don’t know if other medications are discontinued. This can result in potentially dangerous interactions.   

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The other risk is that if a dose is changed on a medication, the patient may be taking the same medication at two different doses. For example if a patient is taking losartan at 50 mg, and it is changed to 100 mg, it is possible the patient may end up taking both doses. 

Then there is the tremendous financial benefit for the pharmacies. It is estimated a patient misses, on average, about five doses per month of medication. If this is a daily medication, it can result in an extra two prescriptions per year. Even if a patient misses just 3 doses per month, he or she will end up with one more prescription to be filled per year. This results in a significant increase in profit for the pharmacy for medication that may never be utilized. 

The pharmaceutical industry also benefits from automatic refills. Someone has to pay for the extra medicine. For Medicaid patients, it is the government and taxpayers and for the commercially insured, it contributes to higher insurance premiums from somewhat falsely inflated medication costs.

When a telemarketer calls you and offers you a service, it is an attempt to make a profit. This is similar to a car dealership asking a client if he or she wishes to add on gap insurance, or extended warrantees. These options would not be offer if there were no financial benefits to the dealership. The automatic refill situation is not very different.

Pharmacies can enroll patients without a signature.  Although automatic refills may be convenient and beneficial for many, it is not without associated risk for some patients. Ultimately, automatic refills equal automatic profits and may result in medication confusion for patients and physicians. 

Make sure when reconciling a patient medication list to keep this in mind, particularly if making any medication changes. On the “Note to pharmacy” section for electronic prescriptions you may wish to specify if any medications are being discontinued at the visit. This may help avoid some confusion for pharmacies and patients.