When patients are prescribed medicine for chronic conditions, studies show, they stick to the schedule for taking the medicine only half of the time.
Proposed legislation aims to do something about that. The bill, A-333/S-3111, would allow pharmacists, with the consent of patients, to be paid extra to synchronize patients’ prescriptions when they don’t begin and end on the same days. Pharmacists already do this for Medicare recipients, but the legislation would allow them to follow the same practice for everyone else.
Pharmacists argue that it’s badly needed, since studies have shown that patients who have prescriptions that are out of sync are 50 percent to 70 percent less likely to take their medications.
Bill sponsor Assemblyman Daniel R. Benson (D-Mercer and Middlesex) said earlier this year that the bill is particularly important for patients who have difficulty getting to pharmacies, including those with mobility issues and those don’t have a support network.
Benson went through the experience with his own mother when he became her caregiver when she was 60. Until she turned 65 and Medicare covered medication synchronization, Benson said it “took a lot” of effort to track the different prescriptions.
The bill would require patients and insurers to pay a “prorated” share of their payments to pharmacists to reimburse them for synchronizing the prescriptions.
Take the example of a patient who takes two drugs for chronic conditions like diabetes and asthma that have 30-day prescriptions that begin and end 15 days apart. Once a year, the pharmacist could provide a patient with 15 days of one of the drugs, and the patient and insurer would pay half of their normal payments to the pharmacy. From that point forward, the prescriptions could be picked up on the same day each month.
In addition to the benefit to patients, pharmacies would benefit because they would receive additional payments from insurers – and because s patients would be more likely to fill and refill their prescriptions.
However, the payments to pharmacists would be less than they would have been under the original version of the bill, which provided pharmacists with full reimbursements to do medication synchronization, regardless of the amount of medication. The final legislation stipulates that pharmacists would only be paid a share of the full reimbursement equal to the share of the prescription covered by the synchronization.
For example, if one 30-day prescription ends 10 days before another, the pharmacist would be paid an additional one-third of the full reimbursement to synchronize the two prescriptions.
It’s particularly common for prescriptions to get out of sync when a doctor changes the dosage of one prescription, Benson noted.
The bill has strong support from a broad coalition of pharmacy, patient, and pharmaceutical advocates.
Two changes were made to the measure in response to concerns raised by insurers. One change excludes opioids, whose high street value could provide an incentive for patients to stockpile and illegally divert them. The other changed the reimbursement to pharmacists from the full reimbursement fee they receive for full prescriptions to the prorated reimbursement.
New Jersey Pharmacists Association CEO Elise Barry said that the biggest financial effect from the bill may be in reduced hospitalizations, since patients who don’t take medications to control chronic conditions can take frequent trips to hospital emergency departments. Barry later said that some patients with multiple chronic-disease medications can make up to a dozen trips to a pharmacy each month.
Those who have medication synchronization are more likely to take all of their various drugs. A study published in the Journal of Managed Care & Specialty Pharmacy in August found that patients enrolled in a synchronization program were 2.3 to 3.6 times more likely to adhere to their doctor’s prescription than other patients.
Fara Klein, a lobbyist for the Washington, D.C.,-based National Community Pharmacists Associations, emphasized that the bill “is not a one-size-fits-all mandate,” since patients would choose whether to opt for medication synchronization.
“Med sync is a shared clinical decision between the patient, the provider and the pharmacist,” Klein said during a legislative hearing in June. Ten other states had adopted similar laws at that time.
Laurie Clark, a lobbyist for the Garden State Pharmacy Owners, said that the bill is s unique in that it gained the support of both pharmacists and drugmakers – “something that you rarely see.”
The Assembly passed the bill by a 73-3 vote in June. The Senate is scheduled to vote on it today.