Case Study: Empowering Pharmacists to Authorize Refills Improves Outpatient Care

Pharmacist-led refill authorization models resulted in improved outpatient care and reduced provider fatigue, asserted Richie A. Romaniszyn, PharmD, BCPS, Operations Coordinator at University Hospitals in Cleveland, Ohio, during a presentation at the 2025 American Society of Health-System Pharmacists (ASHP) Midyear Clinical Meeting & Exhibition.

Romaniszyn presented data from a pilot program implemented in 6 high-volume outpatient clinics in the University Hospitals system, beginning with endocrinology practices and expanding to primary care practices. These practices, Romaniszyn said, represent a problem universal to medical practices nationwide: a high rate of physician burnout (The Physicians Foundation reported these levels at 54%, a decrease from 2024 but still significant enough to impact health systems and patient care across the country).¹ Pharmacist-led refill management, Romaniszyn asserted, would reduce inbox tasks for physicians and their staff, which would in turn reduce their burnout and positively impact their patients’ satisfaction.²

Physician Burnout and Patient Care

Refill backlogs, Romaniszyn said, directly contribute to downstream clinical and operational issues: delayed medication access, inconsistent refill quantities, missed safety checks, and rising frustration among patients and clinic staff. Providers trying to clear refill requests often lack the time to answer patient questions, review labs, or check adherence patterns, increasing the potential for prescribing errors and overlooked clinical red flags. Every one of these things negatively impacts patients in quantifiable ways, but also in one very real qualitative way: every moment that stands between a patient and their medication refill increases the patient’s frustration with their provider and causes a strain on their relationship, which may in turn cause that patient to delay reporting of important health events or seeking care, even for serious or chronic conditions.

Against this backdrop, Romaniszyn’s team tried a different approach: shifting refill authorization responsibilities from physicians to pharmacists. Pharmacists have the specialized medication expertise and often programs to cross-check all medications for potential drug interactions and adverse events, thus preventing those events in patients before they happen. Pharmacists are better able to offer patient support and counseling, better able to track adherence, and often able to recognize and address barriers that providers either do not see or lack the capability or capacity to address. They are also more efficient in processing refill requests and can recommend and even fast-track alternative medications.

A Centralized Pharmacist-Led Refill Model

For their model, University Hospitals used 2 pharmacists and additional pharmacy support staff to handle refill requests through a unified electronic health record (EHR) system. Romaniszyn detailed the parameters established between the clinics and the pharmacists regarding training for physicians, pharmacists, and their staff, such as refill protocols, contact preferences, and which medications the pharmacists could manage.

Over a 12-month period (June 2024 to June 2025), University Hospitals collected data on provider task loads, pharmacist intervention rates, and patient safety indicators. Romaniszyn said they also requested qualitative feedback from doctors and pharmacy staff, and implemented quality improvement changes to the model “to optimize efficiency, scalability, and sustainability of the centralized refill service across additional outpatient sites.”²

Under the model, pharmacists triaged refill requests multiple times a day; Romaniszyn included a sample schedule and workflow in his presentation. Under this model, every refill authorization underwent a structured, 3-step review:

1. Appropriateness: Pharmacists confirmed the medication falls within the system’s approved protocol, the patient was within the required timeframe, and the requested dose and instructions match the provider’s most recent encounter note.
2. Safety: Pharmacists reviewed relevant lab work, assessed renal or hepatic function where applicable, analyzed drug–drug interactions, and communicated with providers where needed.
3. Efficacy: Pharmacists determined whether the patient is adequately controlled on current therapy. If not, they initiated referrals under the collaborative practice agreement (CPA) for medication adjustments, additional monitoring, or adherence support.

The pharmacists also managed clinical messaging, coordinated lab orders, and converted complex cases into referrals for chronic disease management. Under the CPA in place, the pharmacists had full access to messaging and phone records, prior authorization notices, and lab results, and were also empowered to reach out to provider staff to flag patients who were overdue for visits or labs. This, Romaniszyn said, empowered the pharmacists to proactively intervene in patients’ health instead of reacting to fragmented information.²

How Did This Model Impact Physicians and Patients?

Over the course of the 12-month period in question, the 2 pharmacists processed the following number of accepted refill authorizations:

• 4464 refill authorizations in primary care
• 9647 refill authorizations in endocrinology (≈40 per day)
• 1327 pharmacist-led telehealth visits for chronic disease management (≈6 per day)

These numbers underestimate the complete workload, Romaniszyn said, because their system tracks only accepted refill authorizations. He estimated about one-third of refill requests are denied, usually because of incorrect provider information, duplicate requests, or discontinuation orders.

Romaniszyn said providers at University Hospitals supported the pharmacist-led refill allocation as a way to lighten their workloads, though he said the research was still ongoing to provide both hard and soft data on the program. Some of the metrics, he said, would include dollar savings to patient care and intervention tracking for University Hospitals.

Scalability and Sustainability

Although pharmacists command higher salaries than traditional support staff, Romaniszyn outlined several avenues for sustaining or offsetting costs:

• Convert patient concerns into referrals
• Route prescriptions to internal pharmacies within the health system
• Leverage refill authorizations with Healthcare Effectiveness Data and Information Set measures
• Direct bill to clinics seeking to offload the refill workload

Romaniszyn concluded by framing refill authorization not as a clerical task but as a clinical lever. “Implementing a model like this, led by pharmacists, alleviates provider workloads,” he said, “allowing your physicians to focus more on those direct patient care tasks and more complex patients.”

REFERENCES

1. GLIDE Support. The State of America’s Physicians: 2025 Wellbeing Survey. The Physicians Foundation. September 17, 2025. Accessed December 7, 2025. https://physiciansfoundation.org/research/the-state-of-americas-physicians-2025-wellbeing-survey/

2. Romaniszyn RA. (Management Case Study) Optimizing Outpatient Care: A Centralized Refill Authorization Model Led by Pharmacists. American Society of Health-System Pharmacists Midyear 2025 Clinical Meeting and Exhibition. December 7-10, 2025. Las Vegas, Nevada.