Viewpoints: July/August 2013
Refill synchronization is emerging as a new, innovative service for retail pharmacy. The service coordinates all of a patient’s maintenance prescriptions to be refilled on the same day each month. The service provides patients the convenience of a single monthly pickup and the opportunity to discuss all of their medications at once. These programs have the potential to significantly improve patient adherence and outcomes while also improving pharmacy efficiency.
One of the challenges of refill synchronization is how to get started. While pharmacy system vendors, IVR providers, and packaging vendors are offering synchronization solutions, you may want to consider a pilot to start. We will walk you through key areas to consider when beginning a refill synchronization program in the pharmacy.
Goals of the Program
Before beginning a refill synchronization program, it is important to determine your goals for the program. You may want to use this type of service to differentiate your pharmacy from competitors. Refill synchronization can improve workflow; increase sales due to better medication adherence by patients; improve inventory turns; reduce out-of-stocks; and allow precise staffing of pharmacists and technicians — all leading to improved operational efficiency. By communicating with patients prior to their appointed medication pickup day, you may also be able to identify regimen changes and drug therapy problems. Refill synchronization can provide an opportunity for medication therapy management (MTM), a service for which pharmacists can be compensated primarily by Medicare Part D plans today. This would be a complementary service and allow you to schedule a time during pickup to meet one-on-one and review a patient’s medication regimen in-depth. MTM services offer an added benefit to patients and the opportunity for additional profit for the pharmacy.
Refill synchronization is an opt-in program, so identifying the appropriate patients is the first step. Ideal patients for the program are those who have at least one chronic disease and require the use of multiple medications. Target patients should be making multiple visits to the pharmacy to pick up their prescriptions.
The simplest means to identify patients who may qualify for refill synchronization is to measure the number of visits a patient makes to the pharmacy each year, if this information is available from your pharmacy management system or point-of-sale system. Excessive but consistent visits may indicate that a patient is a good candidate for consolidation, as long as he or she has multiple medications for a chronic disease. More complex measures of refill consolidation exist that take into account the both the number of visits and the number of medications. Unfortunately, these measures have significant limitations and are still being refined.
Identifying these potential patients can be a challenge, depending on the reporting capabilities of your pharmacy system and your level of experience exporting and manipulating these reports in spreadsheets. Based on your available data and experience, choose a logical prioritization technique to identify a small number of candidates to proactively contact. Note that some patients enjoy coming to your pharmacy more often as part of their social network. You may want to exclude those patients from your program. A small pilot will identify some stress points for you to address and correct before expanding the program.
Be sure to focus initial efforts on patients whose medication regimens are not so complex that they may prevent you from successfully moving through the initial trial-and-error phase of the pilot. Once through the initial pilot phase, expand the program to double its size to ensure that stress points have been addressed. Further expansion can then occur at a pace comfortable for your pharmacy.
The first measure to track would be program participation. NASPA’s Appointment Based Model Manual suggests starting with 10 to 20 patients for initial enrollment, with a goal of increasing enrollment to 15% to 20% of all appropriate patients taking multiple medications. Additionally, you should track patients’ adherence to their refill date at six-month intervals to determine if patients are improving their adherence. Six months may also be an appropriate time to obtain feedback with a short patient survey.The simplest means to identify patients who may qualify for refill synchronization is to measure the number of visits a patient makes to the pharmacy each year, if this information is available from your pharmacy management system or point-of-sale system.
A refill synchronization program should be designed to improve patients’ health outcomes by improving medication adherence. Calculating a patient’s adherence at baseline and over time can help to 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) may be the more clinically relevant. For more details on calculating MPR and PDCs, see the Viewpoints column in the March/April 2012 issue of ComputerTalk for the Pharmacist.
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 to measure. The main difference between MPR and PDC is that the maximum value for PDC is one and the maximum MPR value can be greater than one to account for early refills. Additionally, PDC will not account for discontinued medications, whereas MPR will.
Refill synchronization is not without its challenges, especially when beginning to implement it. The most common challenges include:
• Identifying and enrolling appropriate patients.
• Determining the best monthly refill or anchor date for each patient.
• Balancing the patient’s anchor dates with pharmacy workloads.
• Reorganizing the pharmacy workflow.
• Managing plan coverage issues related to early refills and partial fills to achieve synchronization.
• Balancing patients’ co-payment issues related to getting all their prescriptions at once, especially as Medicare Part D patients move into the donut hole.
Differentiating Your Pharmacy
Pharmacies will need to work closely with patients, providers, and health plans to successfully execute the synchronization program. For pharmacies, adherent patients can generate profits with increased prescription volume and a more consistent revenue stream. A refill synchronization program is a good way to differentiate your pharmacy, increase profits, and help your patients simplify their pharmacy routine.CT
Ashley Gibbons Ellek, Pharm.D., and Michael Bunn, Pharm.D., M.S., are consultants with Pharmacy Healthcare Solutions, Inc., in Pittsburgh, Pa. They can be reached at firstname.lastname@example.org and email@example.com.
Appointment Based Model
The National Alliance of State Pharmacy Associations (NASPA) has developed a refill synchronization
program known as the Appointment Based Model (ABM). The ABM program provides an ABM manual that guides you step-by-step through the implementation process. Additional materials for use by patients, physicians, and pharmacies are also available and include informational brochures, patient agreements, physician letters, and a pharmacy supply list. All of these materials and more can be found at http://www.naspa.us/grants/abm.html.
Medication Synchronization Revenue Calculator
The National Community Pharmacists Association (NCPA) provides access to a Medication
Synchronization Revenue Calculator, which was developed based on a 12-month study by Thrifty White
Pharmacy. This can be used to calculate the potential increase in gross revenue from implementing a
medication synchronization program similar to the NCPA Simplify My Meds program. You do not need to be a NCPA member to access the Medication Synchronization Revenue Calculator. You can download
the calculator at http://www.ncpanet.org/index.php/preview-of-simplify-my-meds.
Simplify My Meds
NCPA members have access to the Simplify My Meds program, which provides tools and training to
implement a refill synchronization program in their pharmacies. Members can sign up to receive an
operations manual, access to training, NCPA help desk support, and a starter kit of marketing materials. For additional information, visit http://www.ncpanet.org/index.php/preview-of-simplify-my-meds.
Time My Meds
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. For more information, visit http://www.timemymeds.com.