How Does Medication Synchronization Support Medication Adherence?

July 28, 2020 - Medication adherence is a billion-dollar problem in the United States, stemming in large part from challenges to medication management. Leading the charge in overcoming the problem is medication synchronization, or linking medication refills all on the same date.

A seminal 2012 study in the Annals of Internal Medicine revealed that limited medication adherence can cost the US health system upwards of $300 billion a year, alongside nearly 125,000 deaths and 10 percent of hospitalizations.

The causes of poor medication adherence are largely known. Leading the charge is the cost of medication, leaving many patients having to choose between their treatments and paying for essential lifestyle needs, like rent or groceries.

But the other half of that equation is medication management, or the ability for patients to keep track of all of their pills and remember to take them. When a patient has complex chronic illness or comorbidities, they may have to maintain multiple therapies, which can be a daunting task for most.

As the medical industry continues to work to address poor medication adherence, they have begun to tap strategies that can simplify medication management. Foremost, that includes medication synchronization.

What is medication synchronization?

Medication synchronization is a medication management strategy that aligns the refill dates for two or more prescriptions.

When a patient receives multiple prescriptions, it is unlikely the refill dates will all fall on the same day. The patient may go in on the first day of the month, the last day of the month, and in the middle of the month to refill three separate prescriptions, something that is not always manageable and can lead to medication nonadherence.

This can arise from multiple clinicians prescribing those medications or from a single clinician prescribing the medications on separate occasions. Additionally, misalignment of prescription refill dates may stem from prescriptions with different dosages, i.e. a 30-day versus 14-day dose.

Again, this can all be confusing for the patient. Misaligned refill dates mean the patient must make the time to visit the pharmacy multiple times per month and must remember which medication is being refilled and when.

Medication synchronization overcomes this problem by only asking the patient to come into the pharmacy once per month. Pharmacists and prescribers work together to create new dosages or to offer a one-time, limited prescription in order to coordinate all refills on the same day.

Does it improve medication adherence?

Both qualitative and some quantitative evidence suggest that yes, medication synchronization can work to improve medication adherence. Being that some of medication nonadherence can be credited to patient behavior, like having trouble managing more than one medication, synchronization can make it easier for patients to keep track of their pills.

“A lot of patients don't know that pharmacies can do this for them,” Dared Price, PharmD, the president and pharmacist at the Kansas-based Graves Drug, said in a previous interview.

“It seems like once we started asking people, it was almost a no-brainer for them. Absolutely they will sign onto medication synchronization. Us being able to follow through and not mess up in the medication synchronization process confirms to patients that they are going to get the right medication at the right time.”

Medication synchronization doesn’t only work because it times a patient’s regimen in a way that makes sense. Instead, Price said synchronizing doses further reveals medication adherence problems not related to medication management. Timing pill refills, for example, revealed to Price that one of his patients had an exceptionally high bill.

The patient, who had been a patient of Price’s for years, was taking three different medications that in total cost him nearly $1,000 monthly, Price shared.

“I had never put it together that this was costing him all that much and that he was taking some things that could be easily substituted for something else,” Price recalled. “It wasn’t until we got him on a med sync program and I had the ability to sit down and look at everything that I saw these costs.”

After making a few adjustments, Price was able to lower the patient’s bill down to about $100 per month.

The data backs all of this up. A 2019 Government Accountability Office (GAO) report conducted a literature review about medication synchronization plans, finding that some indicated the practice can boost adherence as much as 3 percent.

Other studies went as far as to say that medication synchronization can improve adherence and subsequently improve health outcomes. After implementing the program, researchers observed a drop in hospitalization and emergency department utilization.

A January 2018 Health Affairs study also found medication synchronization increased medication adherence rates by 9 percent.

Challenges to medication synchronization

Although medication synchronization may sound like a simple fix to medication management, it does come with its hurdles.

For one, synchronizing multiple prescriptions that are currently on various schedules presents a logistical issue for pharmacists and prescribers. Pharmacists may need to check with the prescribing physician — and there may be more than one specialist prescribing medications — to adjust the dosage in order to align all refill dates.

To overcome this, pharmacists need to clearly communicate with both patients and providers about a patient’s medication regimen.

“Patients start and stop medication all the time, and doctors change medications all the time,” Price pointed out. “The doctor’s office doesn’t always tell you that they do that. If you're not talking to that patient once a month as a part of a med sync program, then you're not going to know those things and it’s just going to be really difficult to get somebody synchronized.”

The strategy may pose some challenges for the patient as well, the GAO report noted. Aligning prescription refill dates may pose an insurmountable cost a patient may have to pay all at once. There also may be some challenging costs associated with the initial adjustments to align refills.

“For example, 12 of the 14 stakeholders said that some patients may not be able to afford paying all copayments for their medications at one time each month, which deters them from using medication synchronization,” the GAO researchers said. “In addition, one stakeholder said that some patients prefer going to the pharmacy regularly or consider trips to the pharmacy as opportunities for social interaction and may not be interested in medication synchronization.”

Payment plans and prorated costs could help some patients overcome these barriers. And in Price’s case, he was able to use medication synchronization to identify a cost problem and then reduce monthly out-of-pocket spending for that patient by 90 percent.

Other pharmacy and patient engagement experts have said medication synchronization only solves part of the problem. A patient may have aligned prescription refill dates, making it easier for them to manage their prescriptions. However, when it comes time to actually take their pills it’s hard to know which to take and when.

There are drug-to-drug interactions patients must remember, and other instructions that can be hard to track. That has led many pharmacists to take advantage of dose packaging, or the blister packs of medications that can show patients which to take together.

“Medication synchronization still doesn't make it easier for somebody to have 12 pills on a counter and understand, ‘I'm taking this one this morning and this afternoon,’” Alec Gillies, the manager of Buffalo Pharmacies, said in a previous interview. “It just makes it very easy for them to overlook something or to take them too many times.”

By nature, dose packaging synchronizes refill dates, while also serving as a visual reminder of how patients should take their pills.

“The adherence packaging and the co-mingled packaging makes it very simple for patients to understand,” Gillies added. “It's a pretty easy sell for us. Some people still like their pills, and that's fine, but to be able to have all their medications in one simple packet or pouch or blister, with the date, with the time on it couldn't make it any easier for patients.”

Medication adherence and management are critical issues in a good chronic disease management plan. As providers continue to work to keep chronic illness both at bay and under control, it will be essential for them to understand the mechanisms available to maintain adherence.

Medication adherence, and in next steps dose packaging, will be essential steps toward that.