Can patients be given prescription refill durations of longer than the traditional “90 plus one”?
The AMA tackled the topic of extended prescription lengths in its “Debunking Regulatory Myths” series, which provides clarity on regulatory issues for physicians and their care teams to help reduce administrative burdens and avoid guesswork.
While laws and regulations on prescription duration vary by state, generally speaking the maximum is 12 months for noncontrolled substances. But that is starting to change, with at least six states—Idaho, Illinois, Iowa, Maine, South Carolina and Wyoming—allowing for longer durations for noncontrolled substances.
Beyond that, switching from the “90 plus one” refill approach (three months and one refill) to “90 plus four” (which extends the prescription to 15 months) is not only a legally permissible option—it can save patients, physicians and their care teams considerable time and effort.
“More than 84% of all office visits to primary care physicians involve medication therapy, refilling prescriptions for approximately 12 patients each day who were not otherwise counted as an office visit or condition-specific telephone call,” says the AMA’s regulatory myth entry on extended prescriptions. “When these activities are combined with additional administrative and regulatory burdens, primary care teams experience considerable strain and an increased workload.”
As the leader in physician well-being, the AMA is reducing physician burnout by removing administrative burdens and providing real-world solutions to help doctors rediscover the Joy in Medicine™.
There are many benefits
The burden isn’t just on physicians and care teams, though.
"To expect a patient on six medicines to refill them six different times over the course of 90 days just because they are not synchronized is disheartening when so many patients face so many additional challenges,” said one practicing physician in the AMA explainer. “That's 24 trips to the pharmacy for a medicine every year! If the patient doesn't have their medicine, they can't take it and nonadherence leads to poor outcomes."
While not every patient is a candidate for an extended prescription duration, the patients who are and their physicians and care teams can experience a multitude of benefits of changing to such a program. Among them are:
- More medication adherence. Patients are likelier to have continued access to their medications due to not running out of refill authorizations between their annual visits.
- Lower burdens. Those who are stable on their current regimen can have their prescription renewals processed just once a year (or less) instead of at least twice in 12 months. Therefore, medications for stable, chronic conditions can be processed at the same time.
- Less stress. Patients, physicians and pharmacists are all affected when a prescription expires between visits. When patients have extended prescription durations, they can be seen by their physician and medications can be prescribed and filled all in concert with annual visits, which makes refills more predictable and less burdensome for all involved.
“An extended prescription duration contributes to a more efficient practice workflow, reduces administrative burden and increases the time that primary care physicians can spend with their patients,” says the AMA explainer.
For more information about implementing a synchronized, bundled prescription management system in your practice, check out the AMA STEPS Forward® toolkit, “Annual Prescription Renewal.”
AMA STEPS Forward open-access toolkits offer innovative strategies that allow physicians and their staff to thrive in the new health care environment. These resources can help you prevent burnout, create the organizational foundation for joy in medicine and improve practice efficiency.
Earn CME credit
Find out more with the “AMA Debunking Medical Practice Regulatory Myths Learning Series,” which is available on AMA Ed Hub™. For each topic completed, a physician can receive CME for a maximum of 0.25 AMA PRA Category 1 Credit™.
Physicians are encouraged to submit questions about potential regulatory myths and AMA experts will investigate. And, if the matter turns out to be a regulation that unnecessarily burdens physicians or their care teams, the AMA can advocate for regulatory change.
Abstract submissions for the 2025 American Conference on Physician Health—which takes place Sept. 11–13 in Boston—are now open through Feb. 14. Physicians, medical students, residents and fellows are invited to submit abstracts on strategies that prioritize physician well-being, clinical efficiency practices and systemic changes that promote a healthy work environment in health care. Inspire change today and submit an abstract.
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