Theory vs. Application: Pharmacy Auto-Refill

A funny thing happened at the pharmacy today. As a person with the chronic autoimmune condition type 1 diabetes, I make multiple trips to the pharmacy in any given month to fill prescriptions needed for my survival and well-being. Today, the sole item on my list was Humalog fast-acting insulin. I made the familiar walk up to the counter where a new pharmacy technician verified my identity, as usual, before looking for my prescription. 

As the pharmacy tech dug through the "M" basket, he began to look perplexed. When I realized what he was doing, I politely reminded him that my prescription would be found in the refrigerator. He looked relieved to know he was not missing something right in front of his face. When he came back to the counter, this time with a cool boxed vial of insulin in hand, he rang up my co-pay to finish out the transaction. As I signed the box on the PIN pad, he had one more thing to mention. In the same way that an unavoidable laugh might escape when a well-meaning tech asks a T1D about needing a pharmacist consult on the use of insulin, I think I must have giggled when he told me what his screen was telling him. 

It turns out that my monthly supply of insulin was flagged by CVS Pharmacy (formerly Target Pharmacy) as no longer eligible for automatic refills. I inquired as to why this was the case. Surely this is something that could be overwritten by someone on the back end? A couple more pharmacy employees came over to take a look, but there appeared to be nothing that could be done. 

I know it might seem petty to urge further action on something like this, but it just seems silly not to at least try. Automatic refills save time for both the pharmacy and the patient. From now on (or until this issue is resolved), I will have to call or arrive at the pharmacy to request a refill. They will have to take the time to fill the prescription. Inevitably, on occasion, problems will arise from the lack of automation and my endocrinologist's office will have to get involved, or my insurance company will insert themselves into the procedure where their attention is, shall we say, unhelpful. I will come back to the counter and pay for my medication until the next time my disease requires me to have the same conversation with the same people for the same purpose. Same time, same place, same life-sustaining drug, a different month.  

As much as I do understand how "the system" works, as a professional and a patient, I also struggle to truly make sense of why acute illness and chronic illness are so often treated the same way by the healthcare system, when it benefits everyone involved to address chronic illness as the long-term condition that it is. It makes sense not to enroll a course of antibiotics in an auto-refill program. It does not make sense to exclude medication that is required to keep an individual alive on a daily basis, to treat a disease that has no cure. This distinction seems simple to me.

In life, and in diabetes, I have noticed that there is what works "in theory" versus what actually results from practical application of theory. Things like this auto-refill flag, or the quick expiration of prescriptions for chronic conditions, or the way repeated prior authorizations for chronic illness management are treated by insurance companies come to mind here. This is an issue that falls in the middle of that see-saw of commerce vs. care, in a way that is minor and ancillary to other hot topics in the T1D community (like access, patient choice, and drug prices, to name a few), yet still worth mentioning. When small annoyances occur, it is common to feel like it is not worth talking about in comparison to these other Goliath-sized issues, but it is. We should talk about it because it adds unnecessarily to patient burden and there really is not a reason for it to be this way. Why shouldn't we be invested in increasing quality of life by alleviating patient burdens, however small? Even better if it benefits everyone involved in the decision-making chain, from prescribing doctors to pharmacy staff, right on down to the patient.

What am I doing about it? Well, I had a nice conversation with the pharmacy staff about why it is worth exploring if anything can be done to reverse the exclusion on their end (to save time and hassle for us both in the coming months and years). We talked about how it doesn't make sense to treat acute and chronic illness in the same way. They apologized and I told them there was no need. I know it is not their fault. I appreciate that they want to help, for things to be different, even if they cannot make it so. Then I went home and used the unique survey ID given to me on my receipt to give feedback about my experience. If I don't let them know that there is an issue, I certainly cannot expect anyone to try and fix it. I also went to the CVS website and filled out a feedback form. There was no place for me to give them my contact information, so I am aware they will not be following up with me about my experience, but at least I know they now have the information. The number of characters was limited, so I was unable to give the subject as much detail and nuance as I would have liked, but I got the thought out. My feedback form remarks are here below, if you would like to read what I wrote:

My local Target pharmacy recently became a CVS pharmacy. I have overlooked many of the issues during this time of transition, but I wish to bring to your attention an issue that I faced during my visit today. I have type 1 diabetes, so I have several prescriptions that I must fill monthly in order to stay alive. The most important of these prescriptions is the insulin I require to live. When I picked up my insulin prescription for the month of October, the pharmacy tech informed me that the computer alerted that this item was no longer eligible for automatic refill. I asked them to review this, as I will continue to require this drug for the rest of my life, until there is a cure found for type 1 diabetes. It is completely unnecessary to have to refill from scratch each month. The tech was unable to override the alert, so I will now have to call every month. I find this to be an unacceptable practice for your many patients with chronic illness and request your attention to this issue.

I doubt I will have new information to share about this experience, but if I get any relevant information, I will be sure to update or continue this post. I am very curious what similar experiences you may have had in this same area. If you feel comfortable, please share in the comments section. If we talk about it, maybe we can improve the efficiency of the system, or even educate decision makers about these small steps that can be taken to remove miniature pieces of massive chronic burden from the shoulders of patients who could certainly use help in lightening their load. At the very least, if we share our experiences, we can laugh and seek comfort in knowing that we are not alone.