If you have a prescription filled regularly for a chronic condition like high blood pressure or diabetes, it's likely you will be asked about signing up for your pharmacy's automatic prescription refill program. This is most often an option where you have to fill out a form at the store or on the web to request the service, although in some cases the pharmacy may do this without your having to sign up for the service. In either case, based on how many days the original prescription is supposed to last, their computer is set to automatically refill your prescription before it runs out. You can get an e-mail or text message or the system can contact you by telephone to remind you that your prescription refill is due and ready for pick-up.

Once you opt-in for automatic refills, as long as there are remaining refills permitted, every prescription you get in the future will automatically be refilled. If notification has taken place and the prescription is not picked up, another automated contact will happen. About the only complaint I do hear about this service is that it sometimes clogs your voice mail or is it may be a minor annoyance since it's a computer calling you, and not actually your pharmacist.

This service has some great points. It eliminates the need for the patient to remember to request a refill and thus help patients comply with their doctor's instructions. It also helps improve safety since staff at the pharmacy can better prioritize their work flow and they won't feel so rushed. Pharmacists also appreciate it because there's less urgency to dispense on demand since patients don't need to stand by in the pharmacy until the prescription is ready. While this also happens to be good for drug companies since the reminders assure they'll sell more drugs, this is a service provided by your pharmacist, not them. It doesn't compromise your privacy and I'm not aware of any influence on the part of pharmaceutical manufacturers.

Still, there's a potential downside. In the past few weeks we heard from a patient utilizing the automatic refill system who picked up three prescriptions but later called the pharmacy to report he had picked up a blood pressure pill called Norvasc, which his doctor had already discontinued. Fortunately, he hadn't yet taken any. In another case a patient's Cardizem, a heart medication, was increased from 240 mg to 360 mg. The elderly gentleman purchased the new prescription for diltiazem 360 mg but also received the diltiazem 240 mg prescription that had been filled earlier through the automatic refill program. After receiving a call from the confused patient, the pharmacist contacted the patient's doctor to determine which strength the patient should be receiving. Had the patient accidentally taken both strengths of Cardizem, it could have caused serious heart or blood pressure complications.

Rarely do patients or their doctors remember to communicate to the pharmacy that changes in medication therapy have taken place. But if the pharmacist doesn't know about changes the computer is not reset. That increases the risk of a medication being automatically dispensed even after it has actually been discontinued or the dose or dosing frequency was changed. The system just continues to produce labels with instructions that are no longer correct. Sometimes the pill has a new appearance that you may not recognize as being the same drug. This scenario is a set up for inadvertently taking the same medicine twice. Pretty much any pharmacist working in a pharmacy with automatic refills can recall situations where a discontinued medication was inadvertently dispensed.

Patients can also opt out of refill programs either on the Internet or in person, although I am not suggesting that since the convenience of automatic refills is usually a win-win. However, the importance of notifying your pharmacy or having your doctor's office do so when changes are made, cannot be underestimated. In practice this is often overlooked and the older prescription can remain set for automatic refill. If the medicine stays the same but a change is made only to the strength or dosing frequency, it sets up circumstances where drug duplication can occur. Otherwise, the older discontinued medication may still be used when it shouldn't. I'm particularly concerned when patients without insurance, or those who take advantage of pharmacy $4 generic programs, pay cash and shop around. This makes it more likely that not all of your drug information will be in one location and that any duplication will not be recognized. This is one reason why I always advise patients to choose a single local pharmacy, even when they get certain prescriptions through mail order.

Automatic refill programs can help patients adhere to their prescribed medication regimens. They're convenient, you don't need to remember to call, and your prescription will be ready once you get your pharmacy's message, so there's no needless waiting at the pharmacy. But good communication between you and your pharmacist about therapy changes is essential to avoid errors.