I recently assisted a pharmacy in a PBM audit where we had to address unauthorized refills. The PBM was recouping a substantial amount of money because a medical assistant was signing refill authorizations. While medical assistants often sign for refills, they need do so with their supervising prescriber’s credentials.

California law defines medical assistants as persons who may be unlicensed and who perform basic administrative, clerical, and technical supportive services for a licensed prescriber. This means that they cannot prescribe and cannot authorize a refill.

The California Medical Board has the following provision explaining the role of medical assistants in the refill process:  

Can medical assistants call in refills to a pharmacy?

“Medical assistants may call in refills to a pharmacy, under the direct supervision of the physician or podiatrist. The medication refills must be exact and have no changes in the dosage levels. The refill must be documented in the patient’s chart as a standing order, patient specific. Medical assistants may not call in new prescriptions or any prescriptions that have any changes.”

In addition, most PBM pharmacy provider manuals discuss prescriber authorized refills (not prescriber’s agents). The DEA regulations also require only prescribers to authorize refills for controlled substances.

Next time when you receive a refill authorization, ensure that it is signed with the prescriber’s credentials and not by a medical assistant or an agent of the prescriber without actual authority to prescribe.