ADA 2026: Pharmacist Integration Into Refill Workflows Reduces Provider Burnout and Catches Safety Risks

In an interview with Pharmacy Times, Jillian Fetzner, MSN, APRN-CNP, adult nurse practitioner with the Diabetes and Metabolic Care Center and the program director for Diabetes Clinical Care Improvement at University Hospitals, discussed a collaborative practice agreement (CPA) that integrated pharmacists into the refill authorization workflow at her institution. The initiative, presented at the American Diabetes Association (ADA) 2026 Scientific Sessions, successfully processed 3750 refill requests in 2025 without requiring provider involvement, significantly reducing inbox overload. Fetzner highlighted how pharmacists also flagged safety concerns such as overdue labs, drug-drug interactions, and inappropriate dosing—citing metformin and renal function monitoring as a key example. She encouraged pharmacy leaders and health system administrators considering similar models to start by engaging their pharmacy teams directly, noting that provider buy-in and willingness to share decision-making authority are among the most important early hurdles to address.

Pharmacy Times: Can you please introduce yourself?

Jillian Fetzner, MSN, APRN-CNP: My name is Jillian Fetzner, and I am a nurse practitioner at University Hospitals in Cleveland, Ohio. I am currently one of our outpatient endocrinology nurse practitioners.

Pharmacy Times: Can you walk us through what the refill authorization workflow looked like before pharmacists were integrated into the process and what problem you were ultimately trying to solve?

Fetzner: The problem we were ultimately trying to solve was how to reduce the number of messages coming into the inbox. As providers, we have messages coming in—we use Epic, so from MyChart—and we have messages coming in from phone calls and refills, and it gets overloaded sometimes. So it was about reducing the provider’s workload and utilizing the pharmacy team to help reduce those refill requests. Prior to that process, our in-basket was just full of messages, so we would have to take a lot of time to complete the messages, and it just added to our workday.

Pharmacy Times: The study completed 3750 refill requests in 2025 without those ever reaching a provider’s in-basket. From a workflow standpoint, what did that actually look like on the ground? How were pharmacists triaging those requests and deciding what fell within the scope of the Collaborative Practice Agreement?

Fetzner: We met together with all of our pharmacy team to develop a process for the refills, and we developed some protocols that allowed the pharmacy to follow their own protocol or algorithm to make those refills without having to contact the provider. There are some things outside the scope, like controlled substances that have to come directly to the provider or certain medications like vitamin D that need levels—which is provider discretion—so those come directly from the provider. But we had a lot of upfront work to discuss those protocols with the medications.

Pharmacy Times: Beyond workload reduction, the study flagged safety interventions — things like overdue labs, drug-drug interactions, and inappropriate dosing. Can you share a few examples of the kinds of safety concerns your team caught through this process that might otherwise have slipped through?

Fetzner: For example, one thing that is often caught in our practice is metformin. With metformin, we want to keep an eye on renal function. For example, if the patient needed a refill on metformin and they did not have a recent creatinine level or the creatinine level was elevated, the pharmacist could flag that and recommend blood work or ask whether you want to refill this. Together, we can collaboratively do what is best for the patient.

Pharmacy Times: You noted in the conclusion that this CPA model could be replicated across other specialties and outpatient settings. What would you say to pharmacy leaders or health system administrators who are considering launching something similar? Where do you start, and what are the biggest hurdles to get right early on?

Fetzner: I think we have a background of working with pharmacists, and we find a lot of value in having pharmacists on our team. We have two dedicated endocrinology pharmacists—clinical pharmacists—who work directly on our team, and so we are fully invested in the pharmacists and the work that they do. I think some of the conversations need to start with the pharmacy team. I think most of them are willing to partner, and so if you are a specialty that is interested in partnering, I think starting that conversation with your pharmacy teams is the best place to start. Some of the barriers are that some providers do not want to give up control over their refills or decisions being made. But again, we find that pharmacists can definitely be a part of the multidisciplinary team and are crucial, and so we must advocate for pharmacists to be on our team.