Part of the popularity of medication synchronization programs like Simplify My Meds® (SMM) stems from the time patients save by going from making multiple trips to the pharmacy to refill prescriptions to one trip each month.
However, the plan sponsor that runs the prescription drug plan first must allow for partial refills required to sync up the refill schedule. So far, 11 states have addressed this barrier that can delay or prevent patients from taking advantage of this adherence-driving program through legislation.
As the State Pain Policy Advocacy Network explains:
- A partial fill, known as a “short fill,” is often necessary to align the patient’s medications to a single refill date. Many payers do not have payment policies in place to provide coverage for less than a 30-day supply. Thus, patients may be saddled with a full month’s copay for a few days’ supply of medication.
- Pharmacists who attempt to submit a claim for adjusted quantities often receive a ‘refill too soon’ rejection from payers. In these cases, the payer will deny coverage altogether. This requires the patient to pay out-of-pocket to cover the cost for the amount of medication needed to align the refills.
- Pharmacists are not always reimbursed by payers for providing medication synchronization services to patients. The process of medication synchronization enhances workflow efficiency and frees the pharmacist from typical dispensing duties. This allows more time for counseling and medication therapy management. The clinical intervention provided by the pharmacist that is necessary to provide effective medication synchronization is a valuable service that should be included in the patient’s healthcare coverage.
Recently an article ran in the Chillicothe Gazette called “Simplify the prescription process“. Written by Ohio State Representative Tim Ginter (R-Salem), the message perfectly encapsulates why Ohioans, and for that matter the nation as a whole, would benefit if his legislative solution became law:
House Bill 116, sponsored by State Representative Tim Brown (R-Bowling Green) and myself, would seek to provide for partial drug prescription refills for the purpose of synchronizing multiple prescriptions for one patient. Patients with diseases requiring multiple prescriptions, such as heart disease, cholesterol, COPD and high blood pressure, would be allowed to permissively participate in a process with their physician and pharmacist to align their medications so that they can be refilled on the same day.
“Med sync” simplifies patient and caregiver lives by reducing the amount of visits that a patient needs to make to the pharmacy to get his or her needed medication. It reduces confusion related to filling prescriptions, and minimizes the disruption of treatment due to delayed or missed refills. There are currently 17 other states working on similar legislation. Kentucky’s bill was recently signed into law by the governor.
While Ginter referred to the neighboring state of Kentucky as recently enacting medication synchronization requirements—SB 44 was signed into law by Governor Steve Beshear (D) on March 20—other states have also crossed the legislative finish line this year. For example:
- Arizona Governor Doug Ducey (R) signed SB 1288 into law on April 1;
- New Mexico Governor Susana Martinez (R) signed HB 274 into law on April 8;
- In Maine LD 810 became law without the Governor’s signature on May 6;
- Washington Governor Jay Inslee (D) signed SB 5441 into law on May 8; and
- Nevada Governor Brian Sandoval (R) signed SB 250 into law on June 5.
We will monitor when other states pass similar legislation. But regardless, more independent community pharmacies should sign up to offer their patients SMM.