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HLCCompendium
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NDHI<br />
NAT IONAL DIALOGUE FOR<br />
Healthcare Innovation<br />
––<br />
Maintain full dispensing fee payments to pharmacies,<br />
as pharmacist effort is not reduced for<br />
partial refills<br />
Value Delivered<br />
Reform efforts are expected to return significant value<br />
to the healthcare system, because medication synchronization<br />
improves patient outcomes and lowers<br />
healthcare costs.<br />
A medication synchronization program implemented<br />
by a large regional chain pharmacy across a range of<br />
chronic conditions resulted in:<br />
Improved Adherence:<br />
• 3.4-6.1x greater odds of adherence 4<br />
• In all 5 drug classes measured, patients were considered<br />
adherent compared to the control group, based<br />
on proportion of days of medication use covered 4<br />
Increased Time on Therapy:<br />
• 84 days additional medication use per patient per<br />
prescription per year 5<br />
• -73% less likely to stop taking medications than<br />
control group over one year 4<br />
Other benefits of medication synchronization<br />
can include:<br />
• Increased patient and pharmacist engagement,<br />
allowing for greater monitoring and oversight of<br />
multiple-medication regiments<br />
4<br />
Holdford, David A., and Timothy J. Inocencio. “Adherence and<br />
Persistence Associated with an Appointment-based Medication<br />
Synchronization Program.” Journal of the American Pharmacists<br />
Association 53.6 (2013): 576-83. Web.<br />
5<br />
Medication Synchronization: The Value of an Appointment-based<br />
Model. HealthPartners. Web.<br />
• More efficient pharmacy operations, by streamlining<br />
the refill and inventory management processes to<br />
reduce administrative costs incurred by pharmacists<br />
and physicians<br />
In support of the final 2012 rule for daily cost sharing<br />
of medication refills, CMS stated the following:<br />
“We believe that we have sufficiently accounted for<br />
the tradeoffs and implications of the potential impact<br />
of our requirement… [We] specifically accounted for<br />
the additional dispensing fees, as well as the administrative<br />
and programming costs that we believe Part D<br />
sponsors will incur in implementing this requirement.<br />
Despite these costs, we continue to estimate savings<br />
in the hundreds of millions each year to the Part D<br />
program.”<br />
While the estimated total 6-year cost of this rule<br />
to Part D sponsors is $0.5 million, the savings to<br />
Part D sponsors and beneficiaries is $1.8 billion. 6<br />
Path Forward<br />
• Pfizer continues to collaborate with HLC member<br />
Walgreens and other interested stakeholders who<br />
are working to pass legislation in all 50 states.<br />
• 18 states have passed some form of legislation,<br />
regulation, or agreement that promotes medication<br />
synchronization.<br />
• Insurers are now required by CMS to fulfill partial<br />
refills with prorated copays for Medicare Part<br />
D patients, so they have developed the coding<br />
and reimbursement infrastructure for medication<br />
synchronization.<br />
• Pfizer hopes that this advancement in insurers’<br />
reimbursement infrastructure will help drive forward<br />
medication synchronization initiatives.<br />
• In the long term, Pfizer believes that medication<br />
adherence programs will improve patient outcomes<br />
and reduce costs.<br />
6<br />
“Medicare Program; Changes to the Medicare Advantage and<br />
the Medicare Prescription Drug Benefit Programs for Contract<br />
Year 2013 and Other Changes.” Federal Register 77.71 (April 12,<br />
2012): 22071-22175.<br />
Medication Synchronization<br />
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