New Prescription Refill Guidelines Frequently Asked Questions (FAQs)

The following FAQs answer some common questions about the new refill guidelines.

Why are the new prescription refill guidelines, technically called the “Refill Too Soon Enhancement,” being implemented?

The new prescription refill guidelines are being implemented to comply with pharmacy practice standards and regulatory requirements, as they apply to the use of prescription medication.

When will these new prescription refill guidelines become effective?
Beginning on March 2, 2009, the updated prescription refill guidelines will be used to review member prescription history to calculate when the prescription is eligible for refill.

What criteria will be used to calculate when my prescription is eligible for refill?

  • At least 75 percent of the medication must be used, based on the quantity of the previously filled prescription.
  • An excess amount of the medication must not have been accumulated over the past 180 days.
  • Current "Refill Too Soon" logic looks back 30 days from the date a refill is requested to determine if a prescription can be filled. But, beginning on March 2, 2009, the system will now review the past 180 days to determine when a refill is available.
  • The calculation being used to determine the next possible refill date remains 75 percent. Seventy-five percent of the medication should be consumed before a member can refill the prescription. However, now a second calculation is performed to determine the maximum amount of drug a member has on hand over a 180-day period before a prescription can be refilled. The new guideline state that no more than a 30-day supply can remain on hand for a refill to be approved.
  • If scripts are new, and the new script has a change in dose, the look back period begins from zero. This is considered a change in therapy. However, if the new script is identical to the previous script, the system will continue to look back 180 days.

Note: This new refill guidelines will apply whether the refill is ordered at a participating retail pharmacy or via Medco By Mail.

What is the purpose of the “Refill Too Soon” alert?
To provide a DUR (Drug Utilization Review) message to the pharmacist prior to dispensing that effectively minimizes excessive use, waste and the stockpiling of medication.

Can exceptions be made to this policy under certain circumstances?
Exceptions can be made to this policy under certain circumstances. For example, if you’re going on vacation, you may request a vacation supply by contacting 1-800-336-5933.  (Please remember that Medco’s network of participating retail pharmacies extends nationwide, and Medco By Mail can ship anywhere in the United States).

What will happen if I attempt to refill my prescription early?
If you try to order a refill at a participating retail pharmacy too soon, you will be asked to wait until the allowable refill date. If you order the refill through Medco By Mail, the pharmacy may hold the refill until the allowable date.

I still don’t understand these new guidelines. What other resources do I have to obtain more information?
Members can obtain more information by calling Medco at 1-800-336-5933.

Back to top