Auto-Renewal / Auto-Refill Article In Drug Benefit News

“Auto-refill for prescriptions is all the focus lately,” says George Van Antwerp, General Manager of Pharmacy at Silverlink Communications. “Everyone from the big PBMs to the local pharmacies are encouraging this.” This is because auto-refill programs address one of the common patient-reported issues with adherence — forgetfulness — allowing insurers to “minimize gaps in care.” Auto-renewals, on the other hand, are not considered common practice and many payers are hesitant to implement the service.

Express Scripts, Inc. is one of the few PBMs developing an auto-renewal program, which it will offer through home delivery. “Renewals are much more problematic than refills for patients when procrastination occurs,” Bob Nease, Ph.D., chief scientist at Express Scripts, tells DBN. “If you procrastinate on getting a renewal, it’s not just a matter of calling the pharmacy. You have to get a new prescription with a physician. And if you talk to physicians, they pull their hair out over this issue.”

Others contend that auto-refill and renewal programs may up plan costs by increasing medication waste. The concern is that auto-renewals may result in “provisions of medications that may not be a current active medication therapy or where the patient may have experienced an adverse effect and their drug therapy may have been modified by their physician,” contends Andy Szczotka, senior vice president of corporate clinical services at HealthTrans. “This may lead to potential medication waste and increased member and plan sponsor costs.”

“This is all done under the assumption that you’re improving adherence,” [Jerry] Shipkin [from SXC] says. “But I have not seen solid evidence that this improves adherence.”As an alternative, SXC sends its members auto-reminders with phone calls or e-mails to inform patients about their upcoming refill. “This is a more patient-friendly program,” Shipkin argues. “When you measure patient adherence on this program, it’s just not significantly lower than what you might get on an auto-refill program when you calculate the reversal.”

Van Antwerp contends that auto-reminders aren’t enough. “Everyone does auto-reminder programs,” he says. “In my mind, that’s the minimum that a pharmacy or PBM should do.”In addition, he argues, “anything can lead to accumulation if the patient is not using their medication and refilling their drug on a regular basis.” However, “how many patients do that?” he asks. “Drugs cost money.” While it could drive up more prescriptions, “no one’s going to pay for — and/or pick up — scripts they don’t need,” he maintains.

CVS Caremark Corp. claims its “Ready-Fill” program is “a convenience our members love,” according to Bari Harlam, the PBM’s senior vice president of marketing. The program includes auto-refills and auto-renewals. “There are a lot of people that have trouble being adherent, and this is a service that we offer to our consumers that helps do the work for them,” she tells DBN.

CVS Caremark members enrolled in the program receive notifications about their refill a few days before it’s shipped, and have the option of cancelling the refill. The PBM also calls its members’ physicians to request additional refills. “The physicians’ offices view this as part of the normal workflow, and retail and mail pharmacies are always reaching out to them for particular medications,” Harlam says.