(Salem, Ore.) - Reduced trips to the pharmacy, coordinated medication refills, improved patient safety and improved patient compliance – these are the goals of Senate Bill 841, which is moving through Oregon’s legislative session.
Senate Bill 841 addresses concerns held by providers, patients and caregivers alike by allowing patients to line up their medicines so that they can pick them up in just one trip to the pharmacy per month. This allows the patient to coordinate their co-pays, and the comprehensive review by their pharmacist gives the patient the support to ensure he/she is adhering to the provider’s recommendation of taking the right medicines in the right quantity at the right times.
Senate Bill 841 would remove the current barriers to synchronization programs, enabling beneficiaries to synchronize their medications so that they could order and receive them on the same day each month, instead of having to make multiple visits to the pharmacy. This reduces medication waste, as well as the poor healthcare outcomes that result from decreased medication adherence.
Poor medication adherence costs the U.S. health system $290 billion annually and results in avoidable and costly health complications, worsening of disease progression, increased emergency room visits, and hospital stays. The improper use of medicines results in $215 billion in avoidable U.S. health care costs, including $105 billion due to non-adherence alone.
Medication synchronization is not a new program. The model has proven successful in improving adherence and patient care, and thus has been implemented at the federal level through the Medicare Part D program.
State Senator and family physician Alan Bates, D.O. (D-District 3), knows how important this effort is for the patients he serves in his Medford family practice, as he also worked on this issue in the 2014 legislative session. In 2014, the Oregon Legislature passed SB 1579, which required insurance plans to offer medication synchronization programs to their customers. However, the legislation didn’t specify standards for those programs, so barriers still exist to its successful implementation. Senate Bill 841 would create two specific standards for a synchronization program: allowing for pharmacist dispensing fees, and patient pro-rated co-pays.
Joining Sen. Bates in this effort are Sen. Elizabeth Steiner Hayward (D- District 17), Sen. Laurie Monnes Anderson (D- District 25), Sen. Jeff Kruse (R-District 1) and Sen. Chip Shields (D- District 22).
“It’s an innovative approach to improving medication adherence and patient experience with care, because each patient enrolled in the medication synchronization program has a designated day to pick up all medications included in the synchronization plan,” says Sen. Bates. The senator also noted that while Oregon health insurers shared that many have such synchronization programs, such offerings are not well known among enrollees. Senate Bill 841 helps all patients who are enrolled in medical assistance plans, including those who are part of a Coordinated Care Organization, Oregon Health Plan, fee-for-service Medicaid and private, as well as commercial health plans. The only patients this legislation doesn’t apply to are enrollees of prepaid group practice health plans with at least 200,000 enrollees in Oregon.
“Medication synchronization would allow for convenience for patients, better monitoring for adherence and could help facilitate improved refill requests and prior authorizations required from the health care provider,” said BJ Cavnor, executive director of One in Four Chronic Health Collaborative, a patient advocacy organization supporting the legislation. “Medication synchronization includes the pharmacist as part of care team of the patient, which will provide immediate information about dosage, interactions and side effects.”
“The Hemophilia Foundation of Oregon supports SB 841 for a variety of reasons. The most important reason is because our constituents are faced with so many challenges related to their disease and this bill simplifies a small part of what they struggle with each month,” said Madonna McGuire Smith, executive director the Hemophilia Foundation of Oregon.
A recent study by Virginia Commonwealth University reviewed a medication synchronization program at a regional pharmacy chain. The report found that, in comparison to control subjects, patients in the medication synchronization program experienced stronger communication with the complete health care team, had 2.8 more refills/year resulting in 84 more days of medication and had 3.4 to 6.1 times greater odds of adherence. Those not enrolled in the medication synchronization program had a 52% to 73% greater likelihood of discontinuing their medication therapy.
To work effectively, medication synchronization depends on setting a patient-specific date on which all medication refills become due. To accomplish this goal, pharmacies execute certain actions to ensure that all medication for a particular patient becomes due on the same day.
Short-fill prescriptions for the purpose of synchronizing medications require a co-pay for the patient, and to date some health plans have not pro-rated co-pays based on days’ supply, creating a financial disincentive for patients to embrace this successful adherence intervention.
Pro-rated co-pays will reduce the patient out-of-pocket cost for starting on a medication synchronization program. This policy is already being implemented at the federal level. Through recent changes in policy, CMS now allows partial fills in the Medicare Part D program. In implementing this change, and noting that pharmacies should receive a full dispensing fee for partial fills, CMS stated:
“We believe that we have sufficiently accounted for the tradeoffs and implications of the
potential impact of our requirement, both in the proposed rule and in this final rule with comment period. In the preamble and the Regulatory Impact Analysis section of the proposed rule and this final rule with comment period, we specifically accounted for the additional dispensing fees, as well as the administrative and programming costs that we believe Part D sponsors will incur in implementing this requirement.Despite these costs, we continue to estimate savings in the hundreds of millions each year to the Part D program.”
Medication synchronization is not a mandate on the patient, the insurer plan or the pharmacy benefits management organization. Rather, this bill would give the patient the choice to opt-in to medication synchronization should the prescriber and the pharmacist deem it beneficial and appropriate for the patient.
“The evidence shows that medication synchronization improves adherence and lowers overall healthcare costs, although opponents may claim that medication synchronization would raise costs. However, the program has been shown to improve rates of medication adherence and thus lower overall health care expenditures, which is important not only to patients and providers but to employers and companies that do research and development,” said Dennis McNannay, executive director of the Oregon Bioscience Association, which supports passage of the bill on behalf its member companies who make medical devices and medicines to better the lives of Oregonians.
