OBJECTIVES:   In dialysis patients, bone and mineral (phosphorous, calcium) and regulatory hormones (parathyroid hormone (PTH)) become dysregulated, increasing risk of fractures, cardiac events and death.  First line treatment is a low phosphorus diet and prescription phosphate binders.  We examined the impact of a refill management system (RMS) - which helps patients proactively manage their refills using predictive algorithms and refill reminders for prescriptions - on serum phosphorus, calcium and PTH in patients prescribed phosphate binder monotherapy. METHODS:   Data from a large dialysis organization were used to identify dialysis patients prescribed monotherapy phosphate binder between 1/1/2008-9/30/2010 with at least 6 months of follow-up.  Patients enrolled in the RMS were 1:1 propensity score matched to patients not enrolled utilizing age, race, gender, dialysis vintage, body mass index, baseline laboratory values (albumin, calcium, Kt/V, phosphorus, PTH, normalized protein catabolic rate), Charlson comorbidity score, and other comorbid conditions commonly associated with ESRD.  The matched cohorts were compared on the percent meeting guideline ranges for phosphorus (3.5-5.5 mg/dL), corrected calcium (8.4-9.5 mg/dL) and PTH (150-600 pg/mL).  Values were assessed over the 6-months following the first phosphate binder prescription.  Differences between groups were tested using chi-square for proportions. RESULTS: 3,247 RMS patients met the inclusion criteria and were matched 1:1 to a cohort of non-RMS patients.  There were no significant differences between the groups on any baseline variables.  Patients enrolled in the RMS were more likely to be in target range over the 6 month period on all 3 measures: phosphorus (58.0% vs 55.1%); corrected calcium (74.3% vs. 69.1%) and PTH (80.5% vs. 77.2%), compared to propensity matched controls.  All differences were significant at the p<0.05 level. CONCLUSIONS: Results indicate that participation in a pharmacy RMS is associated better laboratory outcomes for dialysis patients.