Pharmacist refill protocol cuts costs, physician time

A pharmacist-centered medication refill protocol implemented by Kaiser Permanente Northwest (KPNW) has greatly improved physician efficiency and medication accuracy – and saved the healthcare system millions of dollars.

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Currently in place at  approximately 20 medical offices and specialty clinics in the Pacific Northwest, the automated medication refill system recently expanded to Kaiser Permanente’s Colorado region. Other Kaiser Permanente regions want to add the program as well.

“It is exciting that it is gaining momentum. I really believe that it is time for pharmacists to relieve prescribers of some of this work,” said Tabitha Fridriksson, RPh, manager of the pharmacy department refill protocol program at KPNW, Vancouver, Wash.

Cost savings

Under the protocol, KPNW pharmacists approved an average of 41,000 refills monthly in 2013, replacing 17 full-time-equivalent physicians and other prescribers and averting 86,376 office visits.

The FTE physician hours handled by pharmacists produced an annual savings of $1.2 million, and KPNW has seen an
additional yearly savings of $480,000, attributed to an increase in the number of prescriptions processed at its Automated Refill Center, “since it is less expensive to process prescriptions there,” Fridriksson said.

How it works

In 2002, KPNW implemented a collaborative drug therapy management agreement with its prescribers, allowing KPNW pharmacists to authorize refills on their behalf and “ensure a set of monitoring criteria take place,” Fridriksson said.

When a patient requests a refill, an electronic refill request in the medical record is automatically sent to a prescriber’s in-basket, which pharmacists can access. “Pharmacists can take action on those messages on physicians’ behalf and sign the prescriptions. The pharmacist action is recorded in the system,” said Fridrikkson.

The pharmacist can refer any concerns to the prescriber. “We add messaging around what the pharmacist discovered,” Fridrikkson said.

Over time, the system has expanded to include various specialty areas, such as decision support for opioid medications. “We have had an 80 percent improvement in timely response for unexpected drug screens.” Next for the program is new software that will automate much of the work of KPNW pharmacists.

“We see technology coming for some of the easy work, so the pharmacist can focus on hard decisions,” Fridriksson said.