title: Community pharmacy automatic refill program improves adherence to maintenance therapy and reduces wasted medication.
abstract: OBJECTIVE
  Automatic prescription refill programs are a popular means of improving medication adherence. A concern is the potential for prescription drug wastage and unnecessary healthcare spending. We evaluated the impact of an automatic refill program on patterns of medication use.
  
  
  METHODS
  Retrospective propensity score matched cohort study with multivariable generalized linear modeling.
  
  
  METHODS
  The setting of the study was a pharmacy benefit manager administering benefits for patients of retail pharmacies. Participants included patients on medication for chronic conditions; those receiving a 30-day supply (n = 153,964) and a 90-day supply (n = 100,394) were analyzed separately. The intervention was the automatic prescription refill program. Measures included medication possession ratio (MPR) and average days excess at the time of refill. The results are reported across 11 therapeutic classes.
  
  
  RESULTS
  Overall, patients receiving 30-day supplies of medication in the automatic refill program had an MPR that was 3 points higher than those not in the refill program; among those receiving 90-day fills and in the refill program, the MPR was 1.4 points higher (P < .001 for both 30- and 90-day fills). The MPR was higher for members in the refill program across all therapeutic classes. Limiting our analysis to members receiving more than 365 days of medication, we found that patients who received 30-day fills and enrolled in the automatic refill program had 2.5 fewer days' oversupply than those in the control group, whereas automatic refill patients receiving 90-day supplies had 2.18 fewer days' oversupply than the controls (P < .001 for both 30- and 90-day fills).
  
  
  CONCLUSIONS
  For this pharmacy provider, automatic refill programs result in improved adherence without adding to medication oversupply.
authors.forename: Olga S
authors.initials: OS
authors.lastname: Matlin
authors.affiliation: CVS/caremark, 2211 Sanders Rd, NBT 326, Northbrook, IL 60062. E-mail: Steven.Kymes@CVSHealth.com.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Kymes
authors.forename: Alice
authors.initials: A
authors.lastname: Averbukh
authors.forename: Niteesh K
authors.initials: NK
authors.lastname: Choudhry
authors.forename: Troyen A
authors.initials: TA
authors.lastname: Brennan
authors.forename: Andred
authors.initials: A
authors.lastname: Bunton
authors.forename: Timothy A
authors.initials: TA
authors.lastname: Ducharme
authors.forename: Peter D
authors.initials: PD
authors.lastname: Simmons
authors.forename: William H
authors.initials: WH
authors.lastname: Shrank
mesh_terms: D002908:Chronic Disease / Q000188:drug therapy; D005260:Female; D006801:Humans; D008297:Male; D054539:Medication Therapy Management; D008875:Middle Aged; D010594:Pharmacies / Q000458:organization & administration*; D055553:Prescription Drugs / Q000600:supply & distribution / Q000627:therapeutic use; D057216:Propensity Score; D012189:Retrospective Studies; D016903:Drug Monitoring
chemical_list: D055553:Prescription Drugs