Some states are considering and enacting legislation for programs aligning patients’ refill schedules.
Medication adherence is a major concern throughout the health care community. Nonadherence can result in many preventable health problems, and factors that lead to nonadherence include forgetfulness, out-of-pocket costs, and polypharmacy.1 With this in mind, many states are considering and enacting legislation to help increase medication adherence.
One proposal that stands out is the adoption of legislation authorizing medication synchronization programs. Some states, including Arizona, Kentucky, New Mexico, and Ohio, have enacted statutes requiring insurance plans to provide a program that allows patients to align their medication refills with a set schedule so that all medications will be ready on the same day.2 In Kentucky, only medications that are used for treatment and management of chronic conditions and that are subject to refills are eligible for this program. This stipulation excludes schedule II or III controlled substances containing hydrocodone. Additionally, all medications must meet prior authorization criteria at the time of request.3 Many other states have followed this outline in their respective bills regarding medication synchronization programs.
Kentucky’s proposal would allow patients to opt into the synchronization program, in which insurance plans, pharmacists, and physicians work together to schedule a single day for the preparation and release of all a patient’s maintenance medications.4 Patients benefit as a result because they need to make only 1 visit to the pharmacy. In addition, reducing the number of pharmacy visits decreases the likelihood that patients will disregard or forget important medications that they have exhausted. Study results have also shown that with the implementation of a medication synchronization program, emergency department visits and hospitalizations have declined by 9%, along with a 3% decline in outpatient visits.5 In addition, reducing the number of pharmacy visits decreases the likelihood that patients will disregard or forget important medications that they have exhausted, in turn avoiding any adverse effects from nonadherence.
Implementation of this program benefits not only patients but also the pharmacists who dispense the medications. Medication synchronization will allow pharmacists to take a closer look at all the medications the patient is using and address any issues that may surface. Pharmacists could call patients a few days before the scheduled pickup date to see whether they have been put on any new medications or discontinued any.6 When the patients pick up all their medications, pharmacists will have the opportunity to perform medication therapy management and offer counseling on the benefits of medication adherence. This can also improve the relationship between the patient and the pharmacists in the community setting.5 More often than not, many encounters in this setting tend to be impersonal and quick. With medication synchronization programs in place, however, pharmacists will have the opportunity to be more involved in the patient’s health care and to assure patients that they are a valuable resource for maintaining their health. With this in mind, patients might feel more inclined to trust what the pharmacist tells them about their medications and the relationship to well-being.
Although a medication synchronization program offers many benefits, pharmacies have encountered some opposition to the program. The idea of having all medications dispensed on the same day seems ideal, but this could lead to increased co-payments or difficulties with insurance coverage.6 Some states, such as Florida, are combating this by requiring insurance plans to cover medication synchronization services at least once during the insured year.7 Kentucky requires private insurance plans to prorate partial quantities for medication synchronization patients.3 Pharmacists can also lower costs by examining the medications that the patient is taking and either changing to less expensive alternatives or discontinuing some altogether.
Overall, medication synchronization programs can assist in many aspects of a patient’s health care. By implementing these types of programs, pharmacists can not only increase adherence but also improve the relationships with patients. States with related legislation already in place can serve as an example of the positive impact the programs have on patients and empower other states to follow suit. Although many obstacles related to medication synchronization still exist, the benefits from increased patient adherence should be a priority.
Tyler Pitcock is a PharmD candidate at the University of Kentucky College of Pharmacy in Lexington.Joseph L. Fink III, BSPharm, JD, DSc (Hon), FAPhA, is a professor of pharmacy law and policy and the Kentucky Pharmacists Association Endowed Professor of Leadership at the University of Kentucky College of Pharmacy.