US Pharm. 2016;41(12):35-37.
Lack of medication compliance and adherence to prescribed medications is a well-known and costly problem, representing nearly two-thirds of Americans who do not take their medications faithfully and as directed.1 This costs the United States healthcare market >$300 billion dollars each year.2 All of the various stakeholders, from payers to pharmacists, have attempted to resolve the issue; yet a comprehensive solution has at best been elusive. In 1995, a novel approach to this issue was conceived by a community pharmacist in Long Beach, California, whereby he implemented the appointment-based model with prescription synchronization.3
Retail pharmacists have the opportunity to build relationships with their patients and, in turn, to leverage these relationships not only to improve medication adherence, but also to provide quality care through medication synchronization—otherwise known as med sync programs. Refill synchronization is thus emerging as an innovative service for retail pharmacy centers interested in better managing patient compliance and total medication cost. Med sync coordinates all of a patient’s monthly maintenance prescriptions to be refilled on a given day and provides patients the convenience of a single monthly medication(s) pickup.
The process of streamlining a patient’s medication refills to a single day each month makes it possible for the retail pharmacist to build structure around the dispensing process. Pharmacists can track and monitor all of a patient’s prescriptions for long-term chronic disease management; this is the cornerstone of improving compliance. Additionally, this simple tracking maneuver creates a bond between the pharmacist and patient, who can work closely together to plan how the patient can better adhere to his or her medication regimen. This also supports the pharmacist in a consultative role with the patient, furthering compliance.
Monetary Benefits of Medication Synchronization
Med sync programs not only offer benefit from a patient perspective but from a reimbursement perspective as well. In many U.S. markets, healthcare is leaning more toward value-based healthcare, providing a unique opportunity for retail pharmacists to demonstrate their value to patients and the healthcare system overall.
The approach to any sustainable med sync program is relatively straightforward (see SIDEBAR 1). Pharmacists should track patients’ adherence to their refill date at 6-month intervals to determine if they are improving their adherence or if the program is having any effect on their general state of health. The 6-month point, or even within the first 90 days, might be an appropriate time to obtain feedback with a short patient survey to see if the program is well received by the enrolled patients.
The major question often asked when contemplating the med sync program is, “Where do I begin and how do I get the program started?” In 2011, the National Community Pharmacists Association (NCPA) developed Simplify My Meds, a program that provides NCPA members with the training, tools, and marketing support to set up a synchronized refill program in their pharmacy.4
For pharmacists, refill synchronization can improve daily workflow, sales opportunities, inventory management, and even staffing issues.5 There is also the opportunity for the pharmacist to engage the patient in medication therapy management services, furthering the patient-pharmacist relationship; this service is compensated by Medicare Part D and, therefore, might benefit both patients and pharmacies.
Calculating a patient’s adherence at baseline and over time can help determine if refill synchronization is increasing patient adherence and improving patient outcomes. Medication adherence can be most easily calculated using the medication possession ratio (MPR), although some will argue that proportion of days covered (PDC) is more clinically relevant. (For more details on calculating MPRs and PDCs, see reference 6.)
MPR measures the percentage of time a patient has access to medication and is calculated as number of days’ supply within a refill period/number of days in refill period. PDC is defined by the number of doses dispensed in relation to a dispensing period and is calculated as number of days with drug on hand/number of days in a specified time interval. Both calculations can result in similar measures of adherence, depending on the time period chosen. The main difference between MPR and PDC is that the maximum value for PDC is 1 and the maximum MPR value can be >1 to account for early refills. Additionally, PDC will not account for discontinued medications, whereas MPR will.6
Med Sync Challenges
Refill synchronization is a step toward improving the adherence and compliance of chronic care patients. Given the arduous task of developing a large-scale med sync program in a busy retail pharmacy, it is important to understand where healthcare technologies can be positioned and utilized for such an ongoing patient-value-added effort.
Some technologies employed in med sync programs include such solutions as Time My Meds by Ateb.7 The pharmacy technology vendor Ateb has developed the Automated Medication Synchronization Solution, Time My Meds, to automate manual processes of a refill synchronization program in the pharmacy. Time My Meds offers automated enrollment and ongoing patient interventions to allow additional time for patient interactions. Using Time My Meds, pharmacies can transition to the Appointment-Based Model (ABM), which enables increased patient engagement, improved adherence rates, and streamlined pharmacy operations.7 Focused med sync tools and technologies need to be integrated with a pharmacy’s existing pharmacy-management system. The pharmacy-management system might provide an automated data feed to a synchronization tool, which determines the best synchronization option for the patient. For example, the Thrifty White Pharmacy chain is employing Ateb, Inc.’s, Time My Meds tool.
Another resource is Pioneer PharmacyRx software, which assists in patient health outcomes by providing early intervention and prescription synchronization.8 Additional resources that prove helpful in med sync are tools and resources such as www.sticktothescript.org, a website from the NCPA focused on medication adherence.9 Simplify My Meds, also from NCPA, provides tools and training to implement a refill-synchronization program. In addition, the National Alliance of State Pharmacy Associations offers ABM support tools, research studies, and other resources.4
Despite the challenges of med sync, such as identifying and enrolling appropriate patients, optimizing or redesigning workflow, implementing the necessary technologies, and managing plan coverage issues related to early and partial refills in order to achieve synchronization, these programs are nonetheless producing results.
Findings suggest that medication synchronization and the ABM can support the efficiencies in getting prescriptions refilled with an improvement in patient adherence. One study showed a 52% to 73% improvement in nonpersistence, based on drug class, and a three to six times improvement in adherence versus a control group.3 Another study showed that patients participating in med sync programs are over 2.5 times more likely to adhere to their medications and 21% less likely to discontinue drug therapy.10
Conclusion
Healthcare continues to struggle with delivering high-quality and value-based care. A cornerstone to this resolution is medication adherence, but it remains an arduous challenge. Medication synchronization and the appointment-based model, coupled together, have the ability to provide opportunities for community pharmacies, not only for better patient outcomes but also for improved bottom lines. Ultimately, if med sync programs are appropriately designed, they offer the pharmacist the opportunity for increasing patient engagement while allowing increasing involvement and interactions from a clinical and quality perspective while minimizing burdensome pharmacy workflow routines.
References
1. Greenberg Quinlan Rosner Research Public Opinion Strategies. Lack of medication adherence harms Americans’ health: results from a US national survey of adults, May 2, 2014.
2. New England Healthcare Institute. Thinking outside the pillbox: a system-wide approach for improving
patient medication adherence for chronic disease. www.nehi.net/writable/publication_files/file/pa_issue_brief_final.pdf August 12, 2009. Accessed September 18, 2016.
3. Pharmacy’s appointment-based model: prescription synchronization program that improves adherence. APHA Foundation White Paper, August 30, 2013. www.aphafoundation.org/sites/default/files/ckeditor/files/ /ABMWhitePaper-FINAL-20130923(3).pdf. Accessed September 18, 2016.
4. National Community Pharmacists Association. Simplify My Meds. www.ncpanet.org/innovation-center/adherence-simplify-my-meds. Accessed September 18, 2016.
5. Ellek AG, Bunn M. Starting a refill synchronization program. Computer Talk for the Pharmacist. July/August 2013. www.computertalk.com/department-columns/viewpoints-july-august-2013. Accessed September 18, 2016.
6. Gibbons A, Krause MS. Measuring the impact of medication adherence programs. Computer Talk for the Pharmacist. March/April 2012. http://phsirx.com/wp-content/uploads/2012/05/Mar-Apr_2012-Viewpoints.pdf. Accessed September 18, 2016.
7. Time My Meds. www.ateb.com/time-my-meds. Accessed September 18, 2016.
8. Pioneer Rx. Medication synchronization software. www.pioneerrx.com/web/blog/DT_benefits/sync/. Accessed September 18, 2016.
9. Adherence programs. www.stick2thescript.org/hcp/index.php/adherence-programs. Accessed September 18, 2016.
10. Painter J, Moore B, Morris B. Addressing medication nonadherence through implementation of an appointment based medication synchronization network. National Community Pharmacists Association.
http://ncpa.co/uploads/Arkansas-Report-Final.pdf. Accessed September 18, 2016.
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