How a physician writes for prescription refills can save that physician a lot of time. I have written tens of thousands of prescriptions over my career, a lot of those were handwritten on prescription pads. I am a member of an increasingly small minority of physicians – those that practiced medicine before the era of the electronic medical record (EMR). When our hospital first contracted with the electronic medical record company Epic, there were many tasks that became much easier and more efficient but there were other tasks that became more difficult and time consuming. The ability to send medication prescriptions electronically to pharmacies was the single greatest benefit.
Before the EMR, I would go through dozens of pads of paper prescriptions every year. I would generally write slowly with big block letters that could be easily read by the pharmacists. But many physicians had notoriously sloppy handwriting with the results that pharmacists would frequently call the physician’s office to clarify a prescription or make their best guess about what the written prescription actually meant (and sometimes got the medication or dose completely wrong). The EMR with its electronic prescription capability changed all of that and allowed physicians to do with a couple of mouse clicks what previously took 30 seconds of handwriting. For my outpatients who came in once a year for an annual visit, I would give them 30-day prescriptions with 11 refills. If they were on a 90-day prescription plan, then I would give them 3 refills.
Intuitively, that should have been enough to get them through the full year until they came in for their next annual visit. But a year after we implemented our electronic medical record, I started noticing that my in basket was regularly filling up with prescription refill requests from patients or their pharmacists.
Doing prescription drug refills outside of a regular office visit is inefficient. You have to do at least a minimum of medication reconciliation for each drug that involves verifying that you are actually the physician prescribing that medication, that the patient still actually needs the medication, making sure that no one else has prescribed another medication that either duplicates or interacts with that medication, and making sure that a new drug allergy has not been entered into the EMR since the patient’s last visit. This all takes time and that time is not reimbursable.
A second thing I began to notice after our EMR had been up and running for about a year was that when patients came in to see me for routine office visits for their pulmonary disease, they would sometime ask me to refill their non-pulmonary medications because they were going to run out of refills a few weeks before their next annual visit with their primary care physician. I found myself prescribing a month’s worth of everything from anti-hypertensives to heart failure medications to Viagra to get the patients through until their next office visit with their other physician. So, what was going on?
Prescribing either a 30-day prescription with 11 refills or a 90-day prescription with 3 refills is a total of 360 days of medication. That is 5 days short of a full year. Moreover, most patients do not come in for their annual visits at exactly 365 days from their previous visit. Most scheduling staff will look for open appointments after 365 days and that generally results in patients being scheduled several days or weeks after the exact 365 day number for their next annual visit. Furthermore, most people do not know their exact weekly schedule 365 days in advance – vacations, work conflicts, weddings, and the kid’s soccer tournament often necessitate re-scheduling the annual office visit. This causes that annual visit to be pushed back even further beyond 365 days. The bottom line is that patients were running out of their year’s worth of refills before their yearly office visit.
A simple solution
In most states, pharmacists are permitted to refill prescriptions for non-controlled medications for up to 12 months. Therefore, by writing a 30-day prescription with 12 refills, that last refill would theoretically be 5 days before the 12 month limit was reached. That would give you and the patient a 25-day window after 365 day mark for that annual visit. It is far more efficient to refill medications at the time that the patient is physically in the office for their regular visit. Moreover, the writing of a prescription (or refilling a previous prescription) can add to the complexity of that office visit, allowing the physician to bill a higher (and justifiable) level of service.
For 90-day prescriptions, if you write for 4 refills, that last refill will be at 360 days (five days before the 12-month refill limit). That gives you and your patient an 85-day window for that annual office visit after the 365-day, 1-year mark. In my own practice, I was almost always booking out more than a month for available return office visits and having that 85-day grace period for medication refills allowed my patients to re-schedule their annual appointments without running out of medications.
The result was that my in basket got a lot less congested with medication refill requests once I put that extra refill on long-term prescriptions. I was happier because my in basket was de-bulked, my patients were happier because they didn’t have to worry about running out of their inhalers, the pharmacists were happier because they didn’t have to take their valuable time calling my office for a refill request, and my office staff were happier because they didn’t have to deal with patients and pharmacists calling our office for refills.
But there is a downside. Anyone who has ever taken a prescription medication has had the experience of getting to the end of the month and finding that there are 3 or 4 pills left in the bottle. It is really, really easy to forget to take a dose, or two, or five each month. So, if left to the patient to go to the pharmacy every 30 days, the patient will invariably go at 32 or 33 days and by the end of the year, they will show up for their last refill a few days after their 12-month (365 day) refill limit. Therefore, whenever possible, get the patient on a 90-day prescription plan, preferably from a pharmacy that mails the the patient their medication refills automatically every 90 days.
The bottom line…
Always write long-term prescriptions as 30-days plus 12 refills. Or better yet, write 90-day prescriptions with 4 refills.
July 29, 2025
