Issue Background

Medication / Prescription Synchronization

SPPAN supports legislation that would:

  • Eliminate barriers to the implementation of medication synchronization, a service that has been shown to improve rates of medication adherence, thereby improving patient outcomes while lowering overall health care costs.
     
  • Benefit the patient, particularly when they are initially prescribed a new medication that has significant risks or when less than a month’s supply of the prescription is clinically appropriate.
     
  • Reduce medication waste created when medications must be changed amidst a 30-day supply.
     
  • Provide patients with the ability to synchronize their prescriptions in consultation with their pharmacists, without having to pay a full month’s cost-sharing when less than a month’s supply of medication(s) is dispensed during the synchronization process.
     
  • Protect a pharmacist from being paid a lower dispensing fee when a partial fill is provided.  A dispensing fee should not relate to the amount of medication dispensed, as the fee is intended to cover operating costs associated with running a pharmacy, such as packaging prescriptions.

Background

The cost of treating chronic illnesses is a major driver of rising overall health care costs.  For many people with a chronic illness, medications are the most cost-effective treatment.  However, patients often miss doses, fail to refill prescriptions on time, and even stop taking their medications without consulting a health care professional. The economic costs associated with medication non-adherence are estimated at $290 billion each year.

The use of medication synchronization is gaining in popularity as a way to improve adherence by patients who are on a regular medication regimen. To coordinate the patient’s recurring medications, the pharmacist performs a comprehensive review of the patient’s medication regimen to determine the appropriateness of each therapy.  After the initial review, the pharmacist calls the patient each month, before filling the new prescriptions, to ensure that no changes have been made and to confirm that the patient is still taking the medication.  This model improves adherence, resulting in healthier patients and a cost reduction to patients, insurers, and the healthcare system as a whole.

Barriers

Though there are many benefits of synchronization, patients and pharmacies face several challenges when trying to synchronize all of a patient’s prescriptions.  

  • A partial fill, known as a “short fill,” is often necessary to align the patient’s medications to a single refill date.  Many payers do not have payment policies in place to provide coverage for less than a 30-day supply.   Thus, patients may be saddled with a full month’s copay for a few days’ supply of medication.  
  • Pharmacists who attempt to submit a claim for adjusted quantities often receive a ‘refill too soon’ rejection from payers.  In these cases, the payer will deny coverage altogether.  This requires the patient to pay out-of-pocket to cover the cost for the amount of medication needed to align the refills.
  • Pharmacists are not always reimbursed by payers for providing medication synchronization services to patients.  The process of medication synchronization enhances workflow efficiency and frees the pharmacist from typical dispensing duties.  This allows more time for counseling and medication therapy management.  The clinical intervention provided by the pharmacist that is necessary to provide effective medication synchronization is a valuable service that should be included in the patient’s healthcare coverage.

Progress Being Made; More Can Be Done

The Centers for Medicare & Medicaid Services (CMS), the nation’s largest payer for health care, is implementing several policy changes that will help remove current barriers to the medication synchronization process, reduce waste from unnecessary fills, and ensure that beneficiaries receive only the medications they need.  Medicare Part D sponsors are now required to apply a daily cost-sharing rate to most prescriptions dispensed for less than a 30-day supply. This provides a common sense approach when patients are trying a new therapy or are attempting to synchronize their refills. Legislation or regulation at the state level could help remove other payers’ existing barriers and encourage the use of medication synchronization programs.

(SPPAN attributes the majority of the content on this page to one of SPPAN's partners, the National Community Pharmacists Association.)