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.
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