Medication Refills Draft protocol - midwest-site



Medication Refills Protocol

Medication refill turnaround time should be no more than 72 hours. Exception: Patient Assistance Program (PAP) requires 4-6 weeks to process. In order to assist providers and patients with meeting this goal, PMA and RNs may authorize refills, under the patient’s regular provider, based on the guidelines below.

Protocol:

1. PMA will review request and follow attached refill protocol to authorize appropriate refills. Any request that needs additional review for authorization will be forwarded to Primary Care Provider (PCP) if in clinic within 2 days or available provider who is in the clinic on the day the request is processed.

2. Refill requests will be processed or patient contacted within 3 business days.

3. It is the patient’s responsibility to contact the clinic one week prior to running out of medications from local pharmacies or one month if PAP refill needed.

Refill requests from:

• Pharmacy via fax: Enter key information from request and forward via EMR according to current workflow.

• Patient request via phone: Patient message should be forwarded to the PMA with key information and may require PMA phone follow-up, then process per EMR workflow.

• Patient request in person and not during a visit: Inform patient or family member that we request 3 business days to process requests and they should check with their pharmacy in 3 days. Verify contact information with each request.

Key information needed:

• Name of medication

• Dose

• Pharmacy

• Patient contact information confirmed as printed on fax or by individual on phone/in person

• Date of last office visit (review chart for recommended RTC; > 1 year automatically needs a visit)

PMA Protocol:

• Refill requests initiated by patient or pharmacy request.

• PMA will process request using the guidelines below and reviewing chart for last visit, last set of required Care Management or monitoring labs and accuracy of medications.

• Medications that are requested but not listed in the medication list should be forwarded to provider for review and reconciliation of list.

• Any patient not seen for greater than one year will need a follow up visit prior to any refills.

• Maintenance: Patient has had regular follow up appointments as recommended by last clinic note and appears to be in compliance with care plan based on timing of refill requests

• Non-adherent: Any patient who has not followed up as requested in last documented clinic note or there is a lapse in timing of medication refills

1. Acid Reflux/GERD

a. Maintenance: 3 months (Needs appointment if using > 1 year)

2. ADHD/ADD

a. Need appointment no less than every 6 months and forward to PCP for written prescription if controlled substance.

3. Allergic Rhinitis

a. Maintenance: 1 year

b. Non-adherent or increase in seasonal symptoms: 1 month and appointment

c. Ok to refill nasal sprays and antihistamines without decongestants

4. Anti-Anxiety

a. Need Appointment no exceptions

5. Antibiotics

a. Need appointment EXCEPT medications for chronic acne

b. Maintenance: 1 month with 2 refills for acne antibiotics

6. Antidepressants

a. Maintenance: 6 months if seen within 6 months

b. Non-adherent: 1 month with follow up appointment

7. Anti-Seizure

a. Maintenance: 6 months or until next scheduled visit if seen every 6 months by PCP.

b. Non-adherent: Must have labs drawn and schedule appointment. To provider for review.

8. Antiviral (Herpes only)

a. Herpes antiviral therapy: PRN refill for 1 year if adherent

9. Arthritis

a. Maintenance: 6 months

b. NSAIDS (ibuprofen, naproxen, diclofenac): Kidney function every 6 months

c. New diagnosis within 3 months: 1 month and follow up appointment

d. Non-adherent: 1 month and follow up appointment

e. NO refills on indomethacin without provider approval

10. Aspirin

a. PRN refill for 1 year

11. Asthma

a. Maintenance: 6 months

b. Non-adherent: 1 month and appointment

12. Birth Control Pills

a. Maintenance: If complete physical within one year and normal blood pressure at last office visit (if pap abnormal, ensure follow up occurred), can refill until next annual physical is due

b. Non-adherent: If pap or annual physical is overdue, patient must schedule appointment and refill until appointment/1 month. If no-showed last appointment, forward request to PCP.

13. Diabetes

a. Maintenance: 6 months if visit within 3 months and HbA1c at goal and BP at goal of ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download