Which reminds me: I know I told this tale here before, but my preventive inhaler (Flovent) suddenly became non-formulary, i.e. not covered/ So doc switched me to another one (Symbicort)… which, interestingly, caused my blood sugar to spike. I was not at that point diabetic but being obese, developing T2DM would not, generally, be a surprise - except at that point I was eating less, walking more, and pulling off a few pounds.
Then I realized the timing - this started happening right after the inhaler switch. I had them put me on a different version of fluticasone which - despite being spendier - was covered/ Problem solved. Then the Flovent was quietly re-added to the formulary.
I currently work for a national pharmacy chain; I previously worked for a PBM, and before that a health insurance company, so I’ve seen this from all angles (other than as a patient - don’t have any maintenance medications of my own).
Follow the money. The pharmacy / mail order facility makes money by filling prescriptions. Of course, they’re going to want to automatically refill scripts, whether you need them yet or not. That absolutely is a problem on the insurance end. Many of our contracts with PBMs have incentives for patient compliance - are they getting their scripts on a regular basis? In that sense, we are incented to autofill scripts, but if the patient doesn’t pick up the script, we don’t get paid (autofill or not), so you get those nag calls - “Hey, your August fill is ready; come pick it up.” Mail Order is worse - the minute they send it out the door, they consider it “filled”, and bill the PBM. Insurance companies and PBMs are now worrying more about over-filling. Let’s face it - you’re supposed to take your atorvastatin every day, but do you? Out of 90 days worth, you might have 10 left at the end of the quarter. By the end of next quarter, it’s 20. Insurance companies don’t make money by paying for things, they make money by not paying for things (and investing your money for 60 days or so, but that’s another discussion for another time), so they don’t actually like autofill. They like you taking your atorvastatin because that (hopefully) means they won’t be paying for your hospital bill after a heart attack, but insurance is a cutthroat business, and any cost-cutting they can do, they’re going to. So, they’re trying to build more checks and restraints into autofills. (PBMs don’t care - they’re just the middle man, and again, if you don’t fill, they don’t get paid, so they prefer the fills).
Notice that none of this takes into account the patient’s portion of the payment. Yes, it is absolutely up to you to say “No, I don’t need this filled this month.”
My wife filled a new prescription at a local CVS, not her usual mail order pharmacy, because it was handy. It was also really expensive so it would have been a one time deal. Except CVS has called twice a day, every day since that RX came up for refill. I blocked the number on her phone but they can still leave a message even tho the phone never rings when they call. Still can’t figure that one out. If you call the number they leave for you, you can not get a real live person. It’s all phone trees and “we are experiencing an unusual number of calls, waiting time is 30 minutes.”
You could try calling the phone number that’s on the prescription bottle and following the prompts to speak to the pharmacist. Then ask the pharmacist to turn off all the crap.
I think my 90-day scrips all autofill at about 9-10 weeks. I don’t honestly know how they do the following autofill (another 9-10 weeks? 90 days from the first autofill?). And my pharmacy is mandated by my insurer, which actually owns it, so…
I CAN request the scrips a bit early - and if I remember to, I do - as I like to have a month or so supply built up in case of errors, non-refilled scrips, etc. It saved me once when one of my meds was in short supply - there was some kind of issue with the ingredients or something, and it was simply unavailable for a month or so.
I day my Warfarin every day without fail, and I still have a surplus. It seems like they try to refill a few weeks before the end of the prescription, which is reasonable so there is no panic ordering. The next time they do it three months - 3 weeks from when you refilled, or 6 months - 6 weeks from the beginning. And so it goes.
I just got told by CVS they wanted to renew my Warfarin with zero copay and free shipping. I may have tons left, but why not? When the copay kicks in next year I’ll have a ton stored up. And I’m not likely to stop taking it.