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Understanding prescription auto-refill schemes

Like virtually all pharmacists in the New York area, you worked hard to pursue an education, pass a licensing exam and build your business. While keeping up with your ethical obligations is an effective way to avoid a legal and professional nightmare, you should know how some pharmacists cross the line. An auto-refilling prescription scheme is one way. 

In a now-infamous case of Medicare fraud, Wal-Mart and Sam’s club paid nearly a million dollars in response to prescription auto-refill charges brought by federal prosecutors in Minnesota in 2018. While the settlement was an infinitesimally small percentage of the company’s annual earnings, it sent a clear message to pharmacists everywhere in the United States that auto-refill schemes are both serious and unacceptable. 

The mechanics of auto-refill schemes 

As their name suggests, auto-refill schemes occur when pharmacists or others automatically refill prescriptions without patient consent. Then, professionals bill Medicare, Medicaid or another federally backed healthcare plan for prescription medication. If patients do not retrieve or use medication, prosecutors may pursue fraud charges against companies or pharmacy professionals involved in the scheme. 

Avoiding criminal charges 

Auto-refill programs are often an effective way to meet consumer demands. After all, patients are often busy and may not realize their prescription medication is running low. Even worse, because medication is often essential for the overall health and well-being of individuals, missing a prescription refill may have serious consequences. Still, you do not want your auto-refill program to run afoul of federal or state law. To stay out of trouble, the Centers for Medicare and Medicaid Services recommends taking three steps: 

  •         Obtain patient consent before push-billing or auto-refilling prescriptions.
  •         Only outreach to patients to improve clinical outcomes and medication adherence.
  •         Avoid using financial incentives when discussing medication processes. 

If you engage in an illegal auto-refill scheme, you may face serious monetary and criminal consequences. By understanding how these schemes work and knowing how to avoid them, you can better plan for meeting customer expectations without losing your license, your freedom or your financial resources.

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