The hazards of auto-refills.

It’s proven that auto refill programs help increase adherence, especially for members with chronic, complex conditions. Convenience and lower prices also top the list of auto-refill benefits — no more waiting in line at the pharmacy and 90-day fills help members save.

Despite the benefits, there’s persisting concern that auto-refill programs increase medication oversupply and lead to higher medication costs. And many states and federal agencies are taking aim at auto-refill programs.  

Citing waste, stockpiling, and CMS payment for unnecessary prescriptions, the U.S. Department of Justice reports that Medicare Part D, an increasing number of state Medicaid programs, and at least 20 state pharmacy boards now prohibit auto-refill programs at both mail-order and retail pharmacies.

“Shipment of unwanted medications is not only wasteful, but also a source of significant beneficiary aggravation and a financial imposition that can negatively affect enrollee satisfaction with the plan,” CMS has asserted.¹

Take mail-order allergy medicine for example: Once the season is over, often members no longer need to refill their prescription. But auto refills may keep filling the prescription, sending the member months of potentially wasteful and unneeded medication.

Reducing oversupply and waste.

Reducing unnecessary waste generated by auto-refills is one of the many ways that MedImpact puts clients and consumers first with flexible and forward-thinking solutions.

Our home delivery program, MedImpact Direct, offers a unique approach to help solve the widespread problem facing plans when PBMs that own or operate their own pharmacies have the incentive to maximize auto refills and keep prices high.

Unlike other PBMs, MedImpact does not recommend auto-refill programs to clients, but when clients opt for auto-refill, MedImpact Direct provides refills at 84% of days’ supply rather than 75% of days’ supply, as is common with other PBM mail-order pharmacies.

Filling at 75% results in stockpiling or nearly one extra 90-day supply each year. And one extra prescription per year for each member taking maintenance medication adds up.

MedImpact manages appropriate utilization without driving up utilization. Contact us at info@medimpact.com to learn how our unique fulfillment model helps reduce waste, lowers costs, and prevents FWA.

Auto refills can play a role in FWA schemes. Read how MedImpact assisted the NY Attorney in a multimillion dollar Medicaid FWA investigation.

^{1 CMS: https://www.cms.gov/Medicare/Health-Plans/MedicareAdvtgSpecRateStats/Downloads/Advance2014.pdf}