Provides for the insurance coverage of the synchronization of multiple prescriptions and dispensing fee standardization

Summary of provisions

Sections 1 and 2 add the following provisions:

(a) provides that a pro-rated cost-sharing rate shall be permitted and applied to prescriptions that are dispensed for less than a 30-day supply for the purpose of synchronizing the covered individual's chronic medication.

(b) provides that drug coverage shall not be denied for a partial fill for any drug prescribed for the treatment of a chronic illness made in accordance with a medication synchronization plan among the insured, a health care practitioner and a pharmacist.

(c) ensures that the dispensing fee stays whole for the pharmacist for a partial fill.

(d) specifies that nothing in his bill requires health care practitioners and pharmacists to synchronize the filling of prescriptions.

Section 3 is the effective date.

Justification

This bill would eliminate barriers to the implementation of medication synchronization, a service that has been shown to improve rates of medication adherence and thus, lower overall healthcare expenditures.

Medication synchronization is a pharmacy service that improves patient adherence to prescribed medications by coordinating the refill dates for all of a patient's chronic prescription medications so these can be picked up on the same date each month. It is estimated that 76 percent of Americans aged 60 and over use two or more medicines and 37 percent take five or more medicines. Patient and caregiver lives are simplified by eliminating multiple trips to the pharmacy each month. It also minimizes confusion over when a prescription is due to be refilled, and minimizes disrupting treatment through delayed or missed refills. The Medication Synchronization model improves adherence and provides a more coordinated level of care; resulting in healthier

patients, and more effective delivery of care which can reduce overall costs to payers and the health care system.

Despite the benefits of synchronization, patients and pharmacies still face several :hallenges when trying to synchronize all of a patient's Prescriptions. A "short fill" or partial fill is often needed to align the patient's medications to a single refill date. Currently, many pavers do not have payment policies in place to provide coverage for a claim for less than a 30-day supply. Therefore, patients are required to pay a full month's copayment or coinsurance for a month's supply of medications, even if questions remain as to the effectiveness or adverse impacts of that medication on that patient.

The Centers for Medicare & Medicaid Services (CMS), the largest payer for health care in the nation, is implementing several policy changes that will help remove current barriers to the medication synchronization process, reduce waste from unnecessary fills, and ensure that beneficiaries are only receiving the medications they need. Beginning January 1, 2014, Medicare Part. D sponsors will be required to apply a daily cost-sharing rate to most prescriptions that are dispensed for less than a 30-day supply. This provides a common sense approach when patient is just starting out on new therapy and may not require a full month's supply, or is attempting to synchronize their refills. State-level legislation would help remove existing operational and payment barriers presented by other payers and facilitate an even greater uptake of medication synchronization programs and other methods that promote adherence and appropriate medication use.

This bill is voluntary for patients, health care practitioners and pharmacists. Nothing in this bill requires health care practitioners and pharmacists to synchronize the filling of prescriptions. It simply establishes a mechanism for medication synchronization for patients with chronic illness when there is a voluntary agreed upon plan between the patient, the health care provider and the pharmacist.

This legislation would:

*Eliminate barriers to the implementation of medication synchronization, a service that has been shown to improve rates of medication adherence and thus, lower overall health care expenditures.

*Benefit the patient, particularly when they are initially prescribed a new medication that has significant side effects, is frequently poorly tolerated, may pose drug-drug interactions with their current regimen, and when Less than a month's supply of the prescription is clinically appropriate.

*Improve the ongoing issue of medication waste when medications are changed during a mid-30 day supply.

*Provide a patient with the ability to synchronize their prescriptions in consultation with their pharmacists without having to pay a full month's cost-sharing when less than a month's supply of medication(s) dispensed during the synchronization process until all medications are on the same thirty or more days refill schedule.

*Protect a pharmacist from being compensated a pro-rated a dispensing fee when a partial fill is provided. A dispensing fee does not relate to the amount of medication dispensed. It is the fee associated with operating costs, overhead, packaging and other costs of operating a pharmacy

Legislative history

New bill.

Fiscal implications

None.

Effective date

This act shall take effect on the 120th day after becoming law.