Refill Authorization

Updated: November, 2025

ALLERMI MEDICAL ASSOCIATES, P.C.

PATIENT AUTHORIZATION FOR AUTOMATIC REFILLS

Allermi has created a system to automatically refill the prescriptions of your choice when they are available to be refilled. By continuing the subscription program, you acknowledge that you are opting-into receiving automatic refills from Allermi's contracted pharmacies for each prescription written for you by an Allermi-affiliated healthcare provider or available refill for that shipment interval. 

By selecting automatic refills of your prescriptions this gives us the time to contact your provider for more refills, order more inventory to fill your order, and ship your order on time.

If you decide you do not want to participate in our automatic refill program any longer, you can easily opt out at any time by cancelling your Allermi subscription. Login to my.allermi.com and navigate to the Account tab and click Manage my Plan in order to manage or cancel your subscription.  To postpone your upcoming refill order, navigate to the Orders tab and click Reschedule.

Once your prescription order has been processed by the pharmacy (meaning it has been charged/billed and sent to the pharmacy to be compounded and shipped) it cannot be refunded.

By acknowledging my consent below, I understand and agree to the following:

I consent to my Allermi prescriptions being refilled automatically and agree to the auto refill permissions and Cancellation, Refund and Return Policy linked here. 

I acknowledge and agree to the Allermi Automatic Refill policy as stated here. I am voluntarily requesting to be placed on this program to improve my health and compliance with my medications. It is my responsibility to notify Allermi of any changes to my mailing address or other information that may affect my medication profile and refill regimen as soon as possible.

I acknowledge that it is my financial responsibility to pay for any prescription that is processed by the pharmacy.

The dispensing pharmacy is not permitted to accept a medication for return to its pharmacy stock once the medication is dispensed and has left the pharmacy premises. This applies even if the prescription has not been opened. 

It is my responsibility to notify Allermi if I wish to discontinue a prescription medication from automatic refill or to disenroll entirely from Allermi's Automatic Refill service.

Notification must be received before the prescription is processed by the pharmacy to avoid financial responsibility for the prescription.