medication synchronization (appointment based model)

[Leper Messiah]

Those of you working in retail know the struggle. Patients make multiple trips to the pharmacy every week just to pick up their maintenance medications because insurance won't pay for their simvastatin until Friday, but they need their lisinopril today, and their metformin and synthroid aren't due for another two weeks. They ask if there is any way for me to bill the insurance for partial fills so that it will all be filled on the same day next time, but our hands are tied by the fact that most of us simply have no way to work that out with the insurance company (short of MAYBE spending an hour on the phone). Why is there no serious push to do something about this? I've read that Publix now has such a program, and I'd love to know how it's working out if anyone can give me input.

If there is a way to "fix" retail, this must be it. Imagine not having to explain to angry customers why their medication was returned to stock when they were told it was ready yesterday. Imagine not constantly having the phone ringing off the hook with refill requests while you do six other things going on. Patients would love this model because of the convenience. Prescribers would love it because of improved health outcomes due to greater compliance, pharmacists would love the organized workflow rather than the chaos we currently deal with, and even the insurance companies would likely benefit due to fewer pointless adjudication attempts and fewer hospitalizations due to noncompliance. The only thing i've heard about the chains is just hearsay that CVS and Wags would like to implement this "in the near future." This model seems like a win for everyone. What am I missing?

---

Members don't see this ad.

 

[farmadiazepine]

I have been syncing meds for patients on lots of medications who I see come into the pharmacy from a few times a week to a few times a month. What I do is bill insurance for partial prescriptions. I tell the doctor that I'm going to put their patient on track with all the medications so they can come only 1 time a month and not get confused. The doctors all agree. Then I partial fill all prescriptions to one date. Then from that one date I start filling 30 day supplies again. The date I pick is usually based on the most expensive medications (HIV), or for expensive packages that I can't open like Advair or PremPro. So far its been working very nice. I've synced a few patients together and they love it. Now instead of seeing them 3 times a month I see them only once a month and we resolve any issues at that one time.

It's so much easier for me to do this at my independent pharmacy. If I was still at CVS I really wouldn't care or make an effort at all to sync meds or get partial prescription's.

 

[Leper Messiah]

even with a partial fill, wouldn't insurance still reject the claim the next time you try to fill a full 30 day supply (say, 5 days later when the othe meds are due)? I've had limited experience with those scenarios so I don't know for sure..

I do know that our number of PCQ calls would go through the floor.

 

[zelman]

I believe there is a bill that is going to force medicare plans to allow this soon. Med synchronization is something CVS is piloting in a few stores, but I don't know how well it's working out. The biggest problem is "quantity limits" that insurance plans have for specific drugs. Often you'll see meds that allow "max 30 tablets per 25 days" and they cannot be synced. If you give a patient 13 tablets to supply meds through their "refill day" you will only be able to give them 17 more when that day comes.

 

[Leper Messiah]

Often you'll see meds that allow "max 30 tablets per 25 days" and they cannot be synced. If you give a patient 13 tablets to supply meds through their "refill day" you will only be able to give them 17 more when that day comes.

my thoughts exactly.

Then again, CVS and Walgreens probably benefit too much by having customers come in 6 times per month instead of once. Those front store sales probably play a big role.

 

[Sparda29]

At the independent I work at, we'd just front it to them and bill when it's due.

 

[zelman]

At the independent I work at, we'd just front it to them and bill when it's due.

Which is all well and good for hctz and lisinopril, but what happens when their insurance stops working and you gave them 15 atripla or abilify 30mg? Just eat that loss?

 

[Sparda29]

Which is all well and good for hctz and lisinopril, but what happens when their insurance stops working and you gave them 15 atripla or abilify 30mg? Just eat that loss?

Ah, we try to synchronize it based on the expensive meds.

 

[Leper Messiah]

For the pharmacies that actually offer these services, is there a simple, smooth way of working it out with the payors, or is it the same headache-inducing time consuming process that I'd have to go through at CVS, where you manually adjust every quantity and deal with the rejections individually? do you actually do MTM on pickup day?

 

[farmadiazepine]

For the pharmacies that actually offer these services, is there a simple, smooth way of working it out with the payors, or is it the same headache-inducing time consuming process that I'd have to go through at CVS, where you manually adjust every quantity and deal with the rejections individually? do you actually do MTM on pickup day?

No, there is no smooth way of working it out with insurance. You have to manually do everything yourself. So, if you feel strongly enough to sync everything together for a patient, usually to the most expensive drug, you have to manually do it and calculate the quantities you want to do so that everything will fill all together in a month orso.

And no, I don't do MTM on pickup day. We're pharmacists, what we do on a daily basis has always been "MTM". If I need to say something to my patients/customers, I'll make sure I do it when I need to when they come in. They don't need a medication review or an intervention or a gap in care that I fill every single time they come into the pharmacy. MTM is academics trying to create something that was always there, and now Mirixa and Outcomes pretty much cashed in on it, and any "MTM" a pharmacist provides will only be reimbursed through a program like them.