Early refills are an early warning signal to audit a pharmacy 

Codoxo uses Pharmaceutical Violations to identify pharmacies that may have improper billing. One of these violations is identifying claims that are potentially refilled too soon. Excessive violations could indicate that the pharmacy is improperly billing and may need further review, such as an audit.  

Filling at 75% utilization 

It is important to review the frequency of refills pharmacies have.  Early refills may be a way to hide that the pharmacy is not dispensing the proper amount. Most PBMs allow pharmacies to refill medications when 75% of the medication has been utilized. For a 30-day supply this would be at 23 days. Keep an eye out for medications that are dispensed consistently at 23 days. As stated earlier this could indicate that the pharmacy is not dispensing a full 30-day supply to patient. If a patient is taking the medication as directed, but states that they keep running out of medication before the 30 days this could be an indicator that the pharmacy is dispensing a smaller quantity than they billed for. It could also be an indicator that the patient is not taking the medication as prescribed and could benefit from further education.   

Excessive Overrides 

For those early fills where the pharmacy submitted an override look at the overrides themselves, specifically for sudden increase in overrides or patients with a higher number of overrides.  

Natural Disasters 

Keep in mind there are certain events that will cause an increase in overrides, such as a natural disaster. For these events, it is recommended that the override date correspond to the event. In other words, if the pharmacy is overriding due to a hurricane then it is expected that the hurricane will correspond to that timeframe and location and not, for example, a month prior.  

Lost or Stolen Medications 

If pharmacy has higher-than-expected overrides due to lost/stolen medication then review if the pharmacy to determine if this is for one patient or multiple patients. If it is one patient it could indicate that the patient is misusing the medication or diverting the medication.  

Incorrect Day Supply Submitted 

Other instances of “early refills” could arise because the pharmacy submitted an incorrect day supply. These will get past refill too soon edits placed by PBMs because it will use the day supply submitted by the pharmacy to calculate the 75% utilization. Codoxo’s Pharmaceutical Violations will identify these claims.  

Increase in Profit 

If a patient fills most of their medications on a monthly cadence, but one or a couple of prescriptions are consistently flagged for refill too soon further review is required. This scenario may be the medication yields the pharmacy more profit and they are trying to dispense as often as they can to increase their profit.  

Concerns with Excessive Early Refills 

Excessive early refills could be indicators to larger problems such as:  

• Billing for medication not provided 
• Patient stockpiling medication 
• Diverting medication 
• Increase risk of abuse  
• Medication waste 

Excessive early refills can be an early indicator that the pharmacy needs further review and possibly an audit. The pharmacy could also benefit from further education informing them of proper billing procedures.