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

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 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

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 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 plemere@iuhealth.org

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.
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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