Thursday, May 21, 2015

Making Patient Adherence Easy: the Value of MedSynch

If you are a patient with multiple chronic illnesses like diabetes and high blood pressure, you could be on four, six, or ten medications. That’s a lot of prescriptions to track, manage, and pick up at the drugstore. A complex regimen of medications could be a major stumbling block toward your medication adherence.

In recent years, medication synchronization or MedSynch, also called the “Appointment-based model” (ABM) has emerged as a tool to combat patient non-adherence and misinformation. This program can benefit anyone taking prescription medication, but is especially helpful for those patients who suffer from chronic diseases, like diabetes, high blood pressure, or heart conditions, with those ages 65+ the target market.

How does the MedSynch model work? What are the pros, the downsides? And, most importantly, is this model beneficial for both patients and pharmacists?

A patient taking part in the MedSynch program has a scheduled day each month to pick up all of his/her medications, typically receiving a reminder call from the pharmacist a few days ahead of time.  On the scheduled day, the pharmacist can review the medication list and discuss drug interactions or compliance issues with the patient. According to the APhA Foundation, this program changes the process from “passively filling prescription orders” to initiating an appointment and interaction with the patient (Pharmacy’s Appointment-Based Model: A prescription synchronization program that improves adherence, APhA Foundation).

The retail chains are getting on the MedSynch bandwagon. CVS markets a medication synchronization program on their website, and Rite Aid advertises the program in its stores.
The leading pharmacist associations are also catching on to MedSynch. The APhA Foundation has urged patients to tell pharmacists to “Align my Refills” (APhA Foundation.org).

In 2011, the National Community Pharmacists Association (NCPA) developed a program entitled Simplify my Meds to aid pharmacists in implementing a medication synchronization program, and MedSynch continues to make inroads among community pharmacies. A 2014 NCPA Digest survey found that 67% of independent community pharmacies offered some kind of medication adherence program. (ncpa.org). In Massachusetts, there are 23 independent pharmacies that have implemented the appointment-based model or MedSynch.

Among these pharmacies is Sullivan’s Pharmacy in Roslindale. Delilah Barnes, a pharmacist and department manager of assisted living facilities in Sullivan’s Long-Term Care Division, focuses on specialty medicine packaging to elderly who are in assisted living or homebound. Barnes synchronizes and organizes the multiple medications in “pop-out” compartments (for morning and night), pill boxes and baggies.

For the past five years, pharmacists in Sullivan’s retail division have executed MedSynch by analyzing the patient’s medication profile and issuing partial refills if necessary, so that all medicines are ready on the same day, Barnes explained. The pharmacists then counsel the patient about any medication interactions and adherence. By reviewing the patients’ profile, the patients’ pharmacists get a sense of the full picture. “You need to look at the patient as a whole...not at an individual prescription,” explained Barnes. “MedSynch is made to see the patient as a whole.”

Similarly, Brian Ambrefe, a pharmacist and owner at Village Pharmacy in Lynnfield, has performed medication synchronization for the past eight years.  Ambrefe says patients who take four or more medications or who meet Medicare guidelines for Medication Therapy Management (MTM) comprise the majority of MedSynch patients, though Village Pharmacy offers this option to anyone who could benefit from it. To sync, Ambrefe starts with the most expensive drug (known as the “anchor drug”) as the basis for the refill schedule, then works the other refills around this one, resulting in partial refills until the “synch” is complete.

Moving to a MedSynch or appointment-based model offers several advantages for the patient, the pharmacy, and the healthcare system. Patients enrolled in the ABM were “three to six times more likely to adhere to their medication regimes than consumers who were not enrolled,” at least in part because they felt a greater connection with the pharmacy, according a study from Thrifty White Pharmacy referenced by the APhA Foundation. Patients were also more likely to be content with the care they received from their particular pharmacy, with fewer trips to the pharmacy being one reason for their satisfaction.

Similarly, MedSynch provides benefits to the pharmacies that implement it. Ambrefe says MedSynch makes operational planning easier; he can make fewer deliveries to assisted living facility customers, and can arrange staffing levels more accurately. MedSynch also allows for inventory management. Ambrefe can order medications from wholesalers very shortly before his patients are due to pick them up, so expensive drugs never remain on the shelf for very long.

From a more global perspective, patient non-adherence is one of the largest drivers of healthcare costs, so a program like MedSynch that positively impacts adherence has the potential to bring healthcare costs down, as well as impact specific improvement metrics. “The measures of improvement will be useful to align the impact of pharmacists utilizing the ABM with the quality measures (e.g. CMS Five Star Quality Ratings) and cost savings many doctors, hospitals, and payers are striving to achieve.” (APhA Foundation). The CMS Five Star Quality ratings evaluate a drug plan according to member satisfaction, patient safety, and more.

Though the benefits of MedSynch are plentiful, there are still downsides.  Most of these center around cost, both to the patient and the pharmacist.  It may be a financial hardship for patients to pick up and pay for all of their monthly medications at one time, especially if their insurance will not cover the partial refills.

Slowly, this may be changing. While insurance coverage of partial refills varies from plan to plan, insurers have been covering these refills more frequently in recent months. Medicare Part D drug coverage of partial refills has changed. “As of January 1, 2014, changes under Medicare Part D required plan sponsors to offer prorated copayments, accomplished through new submission clarification codes, to Medicare beneficiaries for medication synchronization” (pharmacist.com). Brian Ambrefe has noticed just this year that insurance plans have gotten better at covering the prorated refills.

For plans that initially don’t cover partial refills, a pharmacist’s persistence can go a long way, says Barnes. She often will contact the insurance company to get these refills approved and the patient synched.

Pharmacists also experience a disadvantage because insurance does not cover the work involved in MedSynch, including organizing refills and patient counseling. While pharmacists can get paid for some Medication Therapy Management (MTM) encounters, these patients often get “cherry picked” by the Pharmacy Benefit Managers (PBMs), according to Ambrefe.

Synching prescriptions may also result in an overabundance of medication for the patient. Sometimes, a doctor will tell a patient to stop taking a certain medication, but no one communicates this to the pharmacist. With MedSynch, the particular prescription keeps getting filled. Similarly, if a patient picks up their prescriptions, then becomes injured and goes to a rehabilitation facility, he or she won’t need their medicine at home, and it piles up, says Barnes.

In addition, a pharmacist needs to be aware of certain situations that may arise with the ABM. When meeting with the patient, pharmacists should be on the lookout for potential patient misuse of controlled substances, says Barnes.


With pharmacists on the cusp of potentially earning provider status, they will have an opportunity to influence patient adherence more than ever before. MedSynch can be a valuable tool in their kit. Like any tool, though, it has its limits. While MedSynch improves adherence significantly, it is not a magic bullet. “Adherence is better, not absolute,” states Ambrefe.