Characterization of medication refill models in U.S. ambulatory care: A scoping review of program types, barriers,...

Programs for prescription refill authorization have been implemented within ambulatory care improving work efficiency; however, the breadth of evidence related to their characteristics and outcomes is unknown. The primary aim of this scoping review was to describe the characteristics and outcomes of medication refill programs in ambulatory care in the United States. Additionally, barriers and facilitators of implementing these programs were assessed.

This review was conducted following the Joanna Briggs Institute guidelines. Published abstracts and articles from 2010 through March 2025 were included if they described medication refill programs implemented in ambulatory care in the U.S. PubMed, Embase, CINHAL, and Web of science databases and gray literature were searched. Study descriptive characteristics are reported. The qualitative data were analyzed using thematic analysis.

A total of 2449 citations were assessed, and 25 studies were included in the review. Two overarching refill model types were reported. First, single-office models that typically manage low volumes of prescriptions and often focus on a narrow disease group. Second, there were centralized models featuring high levels of automation and protocol use, serving many clinical offices. Most studies reported prescription refill volume as an outcome. Seven themes captured barriers and facilitators related to the implementation of medication refill models.

This scoping review identified a variety of medication refill models implemented in U.S. ambulatory care settings. These models supported diverse organizational configurations and made extensive use of electronic medical records to streamline processes. Notably, pharmacists played a central role in the majority of most of these programs, highlighting their critical contribution to effective medication management and patient care in this setting. Barriers to program implementation related to professional role negotiation and resistance were reported. Facilitators such as the use of automatic refill protocols, workflow integration, and use of centralization supported the implementation.