The logical first question is "are there REALLY no refills left?" At least, that's what the provider will want to know. Even though the provider and his staff should know or be able to find out from the patient's record when the prescription was originally written and how many refills it was written for, the provider has no way of knowing how many times the patient has actually had the prescription filled. The provider would need to contact the patient's pharmacy to find out. The pharmacy, on the other hand, should have that piece of data more readily available and, most importantly, accurate. If the first question can be best answered by the pharmacy then that's where the event should begin.

All that to say.... the patient should initiate the process with the pharmacy.

There is much more to renewing a prescription than verifying past refill history. A physician should verify that the therapy is working as expected. The new dispense transcations and histories available from Surescripts can provide the refill history directly to the physician. This in combination with lab results and visit history will provide the physician with the appropriate information to make a refill authorization decision. In many cases, the physician needs to have direct interaction with the patient. Isn't this the reason prescriptions expire?
Research has shown that if a Pharmacy receives the refill requests directly from the patient and sends it to the physician that the physician office saves costs. Isn't this obvious? This workflow allows the physician's office to use the pharmacy as a refill answering service. The pharmacy gets no compensation for this service and pays an additional e-prescription transaction fee for sending the request, doubling their eprescribing transaction costs. To top it off, if the renewal is refused, the pharmacy needs to call the patient back.
In short I have seen no studies that provide evidence of a benefit to pharmacy to initiate renewal requests.
Eprescribing vendors do recommend that physician's offices tell their patients to call renewal requests into the pharmacy rather than direct to thier offices. The value of this workflow is reduced work for the physician office staff and increased revenue for the technology venders but little value evidenced for the Pharmacy.
Ultimately the workflow should be determined by what is best for the patient.

Actually, it isn't obvious. Especially for those of us IT professionals who are involved in eRx on the provider side. I only have the experience of the providers to rely on, and as you've mentioned there are no studies. That's what is good about this wiki, and why I was excited to participate. I've been in many meetings where the question has come up, "What would the pharmacist say?" For this particular topic, I now have my answer, so thanks. I can't say that my providers would agree with you, but that seems to be a common theme with eRx - how do we meet the needs of the pharmacy, the provider and the patient in the most efficient, and cost-effective manner?

In this case, I think you hit on an important aspect - refill history provided via Surescripts. This is a feature we have yet to implement.