Pharmacy Technician-Lead Refill
Authorization Service Team (PhAST):
Patient and Provider Impact Across
Multiple Practices
Peter LeMere, PharmD
PGY1 Pharmacy Resident
Indiana University Health Arnett
Preceptors:
Jenelle Rogers, PharmD, BCPS
Carrie Krekeler, PharmD, BCGP
David George, RPh, MBA
Jennifer Noonkster, CPHT
Conflict of Interest Statement
▪The speaker and preceptor have no actual or potential
conflict of interest in relation to this presentation
2
Background
Prescription • Managed by physicians and office
refill requests employees
Provider • Patient care and communication
responsibilities • Refill requests
•Lengthy refill turnaround times
Patient effects •Adherence in chronic disease states
3
Shanafelt. Mayo Clin Proc. 2017, Rim. Am J Health Syst Pharm. 2018, Schlosser. J Am Pharm Assoc. 2020
Background
▪Existing literature
▪Refill request verification lead by pharmacy technicians
▪Workflow/protocol
▪Findings
⎻ Increased quality and quantity
⎻ Decreased refill turnaround time
⎻ Decreased physician workload/burnout
▪Pharmacy staff role expansion
▪Technicians
▪Pharmacists
4
Schlosser. J Am Pharm Assoc. 2020, Nguyen. J Prim Care Community Health. 2015, Rim. Am J Health Syst Pharm. 2018
E-Rx Workflow
Protocol med? Same provider? If refills available →
Chronic med? Provider within Reject (too soon)
(>9 mo) network? Recent refills?
No labs/appointments “Yes”
Med discontinued to all Approve
within time range →
→ Reject steps refill
Reject
Dose/info match? request
Up to date?
Forward
“No” to any step to
provider 5
Question #1
▪Which of the following is a positive impact of streamlining refill
requests with pharmacy technicians?
A: Decreases pharmacy technician burnout rates
B: Reduce turnaround time for controlled medication requests
C: Increase medication adherence
D: Reduction in pharmacist workload
6
Question #1
▪Which of the following is a positive impact of streamlining refill
requests with pharmacy technicians?
A: Decreases pharmacy technician burnout rates
B: Reduce turnaround time for controlled medication requests
C: Increase medication adherence
D: Reduction in pharmacist workload
7
Methods
Retrospective chart review
• Feb. 2022 – Feb. 2023
• 3 Indiana University Health Clinics: Greenbush, Frankfort, Otterbein
• 5-8 primary care providers, urgent care, radiology services
Refill requests
• Processed by technicians
• Protocols for approval/denial
• Non-protocol requests forwarded to provider's office
Requests received via
• Electronic prescriptions
• Consumer messages or voicemail
• Fax 8
Methods
▪Data collection
▪Outcomes recorded manually
▪Excel and physical forms
▪Audits performed for accuracy
▪5-20% of daily processed requests
▪Verify prescription details
image: Flaticon.com
9
Primary Endpoints
Percentage of requests not sent to the provider
Completion
including approved per protocol, discontinued
Rate medications, refill too soon, and duplicates
10
Primary Endpoints
Percentage of requests not sent to the provider
Completion
including approved per protocol, discontinued
Rate medications, refill too soon, and duplicates
Non-
Reasons for requests sent to the provider that did
Completion not meet protocol and/or required further review
Reasons
11
Secondary Endpoints
Processing Time taken to review each request and decide eligibility
Time and further completion
12
Secondary Endpoints
Processing Time taken to review each request and decide eligibility
Time and further completion
Turnaround Time between receiving refill authorization request from
Time patient/pharmacy to decision to complete/deny
13
Secondary Endpoints
Processing Time taken to review each request and decide eligibility
Time and further completion
Turnaround Time between receiving refill authorization request from
Time patient/pharmacy to decision to complete/deny
Proportion of completed requests without errors in
Accuracy Rate medication name, strength, frequency, directions, or
provider
14
Secondary Endpoints
Processing Time taken to review each request and decide eligibility
Time and further completion
Turnaround Time between receiving refill authorization request from
Time patient/pharmacy to decision to complete/deny
Proportion of completed requests without errors in
Accuracy Rate medication name, strength, frequency, directions, or
provider
Refill requests denied per protocol which may have
Good Catches resulted in patient confusion or harm
15
Medication List / Protocol
Chronic disease state medications for:
• Hypertension
• Diabetes
• Hyperlipidemia
• Depression
• GERD
As needed medications:
• Anti-nausea
• Anti-migraine
• EpiPen
• Albuterol Metered Dose Inhaler 16
Results – Completion Rate
Not Completed
Completed
0 5000 10000 15000 20000 25000 30000 35000 40000
Refill Requests (N)
Total refill requests Completion
processed: 58,609 Rate: 63.8% 17
Results – Reasons for Non-Completion
Provider <9 months
Follow-up Required
Med Alert Message
Other
Labs Required
Med <9 months
Controlled Med
Non-protocol Med
0 2000 4000 6000 8000 10000 12000
Refill Requests (n)
18
Results – Secondary Endpoints
Average
Processing 6 minutes
Time
Average
Turnaround 26 hours
Time
Accuracy 98.68%
Rate
19
Results – Secondary Endpoints
Good 600 total
Catches
Average of 50 per month
Types 63.0% Discontinued medication
30.1% Dose change
3.6% Titration/taper
3.3% Other
20
Good Catch Example #1
Pharmacy Chart review Patient on Technician
requested showed separate called Old
refill for medication medications, pharmacy to medication
lisinopril/ was not discontinue deactivated
HCTZ discontinued combination medication
21
Good Catch Example #2
Pharmacy requested refill
for atorvastatin 10 mg
Chart review showed recent
increase to 20 mg
Technician denied
request
Advised to inactivate the
prescription
22
Good Catch Example #3
Pharmacy
requested refill Chart review: Dose change
Prescription
for insulin instructed to at hospital
inactivated
glargine 60 take 30 units discharge
units daily
23
Question #2
▪Interventions made by pharmacy technicians can improve which of
the following aspects of prescription quality?
A: Ensure follow-up appointments are made to assess the
appropriateness of medications
B: Making therapeutic interchanges to help with financial
assistance
C: Correcting dose errors on refill requests using chart notes
review
D: A and C
24
Question #2
▪Interventions made by pharmacy technicians can improve which of
the following aspects of prescription quality?
A: Ensure follow-up appointments are made to assess the
appropriateness of medications
B: Making therapeutic interchanges to help with financial
assistance
C: Correcting dose errors on refill requests using chart notes
review
D: A and C
25
Limitations
▪Lack of initial baseline data
▪Refill request turnaround time
▪Error rates
▪Physician processing time
▪No initial data
▪New program growth
▪Averages skewed
26
Conclusion
Pharmacy technicians
• Handled large volume of refill authorizations
• Protocol-based decisions on >2/3 of requests
Efficiency
• Processing time reduction
• Allow for increased total volume
• Turnaround time reduction
• Allow for better patient adherence
• Weekday requests < 26 hrs
Quality
• Prevent patient confusion and/or harm 27
Future Directions
Expansion of the refill authorization
service team
• Primary care practices
• Pediatrics
• Specialty offices
Addition of a pharmacist
• Process non-protocol requests
• Allow for clinical review
28
Questions?
Contact Peter LeMere at [email protected]
29
References
1. Schlosser EG, Neff E, Francis SM, Vormohr H, Hincapie AL. Implementation of a protocol-driven pharmacy technician refill process at a large physician network. J
Am Pharm Assoc (2003). 2020;60(6):e341-e348.
2. Nguyen M, Zare M. Impact of a clinical pharmacist-managed medication refill clinic. J Prim Care Community Health. 2015;6(3):187-192.
3. Rim MH, Thomas KC, Hatch B, Kelly M, Tyler LS. Development and implementation of a centralized comprehensive refill authorization program in an academic
health system. Am J Health Syst Pharm. 2018;75(3):132-138.
4. Shanafelt TD, Noseworthy JH. Executive leadership and physician well-being: nine organizational strategies to promote engagement and reduce burnout. Mayo
Clin Proc. 2017;92(1):129e146.
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technician#get-certified.
6. Bhakta K, Lee KC, Luke T, Bouw J. Impact of a pharmacist-run refill and prior authorization program on physician workload. J Am Pharm Assoc (2003).
2022;62(3):727-733.e1
7. Baron RJ. What’s keeping us so busy in primary care? A snapshot from one practice. N Engl J Med. 2010;362(17):1632e1636
8. D’Achille KM, Swanson LN, Hill WT. Pharmacist-managed patient assessment and medication refill clinic. Am J Hosp Pharm. 1978;35(1):66-70.
9. Jones RJ, Goldman MP, Rockwood RP, Imhoff TE. Beneficial effect of a pharmacist refill evaluation clinic. Hosp Pharm. 1987;22(2):166-168.
10. Suzuki NT. Pharmacy medication refill clinic decreases waiting time for patients. Am J Hosp Pharm. 1987;44(1):64, 67.
11. Jones RJ, Goldman MP, Rockwood RP, Imhoff TE. Beneficial effect of a pharmacist refill evaluation clinic. Hosp Pharm. 1987;22(2):166-168.
12. National Healthcareer Association. NHA certified pharmacy technician (CPhT): test plan for the EcCPT exam. Available at: https://www.nhanow.
com/docs/default-source/pdfs/exam-documentation/test-plans/nha-2016- excpt-test-plan_public_detail.pdf?sfvrsn=2
13. National Healthcareer Association. NHA certified medical administrative assistant (CMAA) test plan. Available at: https://www.nhanow.com/docs/ default- 30
source/pdfs/exam-documentation/test-plans/nha-certified-medicaladministrative-assistant-(cmaa).pdf?sfvrsn=2
