The secret to refill synchronization

Actually, the secret to refill synchronization is really no secret. Its just a little bit of planning, a little work, and a not a lot of annoyance. I’ll speak from personal experience. I’ve worked at two of the large chains, trialed and provided feedback on a refill sync program, and frankly nobody has it right. Refill sync is not rocket science. I’m gonna show you how to do it yourself without much effort at all.

Get the basics down first

If you have several medications and use any of the large chain pharmacies you have probably been aggravated to death about “getting all your meds on one day”. Sipping that secret sauce tells us that people that have their meds synced up on average are at least 9% more adherent to their medication regimens. In the grand scheme of things that means those people are getting more benefits from their medications, are less likely to end up developing a complication from the very diseases we are trying to treat, and are less of a cost burden on the healthcare system. But…for a good sync program to work you have to have an engaged patient. It just won’t work well without one of two things: the pharmacy staff killing themselves to manage your meds or you (the patient) actually getting involved in your healthcare.

First up: Know your meds

This should be common sense, but as a pharmacist I can tell you that at least 75% of my patients probably could not tell me what all of their medications are for. When you take that medication you are making a conscious decision to take care of yourself. It may be poorly done, but you are still making that decision. You probably would not walk out in front of a moving bus on purpose, correct? Medications can kill you just as quickly if taken incorrectly, so don’t you think you should know what you’re on and why you’re on it?

Next up: Spring Cleaning

Okay, so this may not apply to everybody. But if you are one of those people that literally holds on to everything in the hope, or delusion, that it may be useful again later…this is for you. Empty out your medicine cabinet. Get all of your OTC items. Get anything that may have a printed expiration date. Now check ’em. Medication is not good forever. I kid you not, I had somebody ask me once if they could still use some Silvadene cream that expired in 2013. Part of my soul died. If it is expired, it needs to go. Antibiotics you didn’t finish? We need to talk about that, but they still need to go. Congratulations, you’ve taken the first step in being a responsible patient that pharmacists don’t want to choke out. Next step is to “X” all those open bottles.

Moving on: Make a med list

This should be easy now. Take your medications and put them in a list. I’ll even provide you a blank list, download it from here. Make sure you include all the information on the sheet. Why? Because the most common call I usually get on the weekends is from the hospital requesting a medication list on a patient that has no list. Most often, the patient is unconscious or has no clue what they take. Having a list speeds up the process and makes it more likely the hospital will get your meds right the first time.

Sync up

Last step, lets make a sync plan. Before we get started, let’s get some basic rules out of the way.

Step 1: Pick a target date

By target date all I mean is the day you want to pick up your medications. You can pick one, two or three. If getting all of your medications on one day is going to be too expensive split it up. It is a little more complicated, but once you see how doing it for one day works you can easily do it for multiple sync dates. I’ve got a few recommendations for picking that date:

Step 2: Identify any “short fills” needed

The challenge with refill synchronization is that the prescription insurance companies don’t care. Even if you’re trying to sync things up to make things easier for you and potentially less costly for them, you can’t get your medications early. So, to work around that we use what we call short fills. The concept is easy.

Say you pick a sync date of 10/10. You got a medication due on 10/1. Instead of getting the full 30- or 90-day supply on 10/1, you are going to get 9 days worth of medication. Then, on 10/10, you will pick up that same medication again for the full 30- or 90-day supply.

Step 3: Check for any medications that are out of refills or expired

Before diving into your sync plan, check your bottles. Look for any that have no refills remaining or, just as important, are expired. For those that are unaware, refills do expire. Laws vary by state, but in general refills usually expire 1 year after the date your prescriber wrote the prescription. Most bottles will say “1 refill before xx/xx/xxxx” to tell you when you’ll need a new prescription.

You will want to either have the pharmacy request those refills prior to needing them or reach out to your prescriber directly. Most offices now want the pharmacy to electronically request those refills. You should, at a minimum, allow 3 business days for a response to the pharmacy’s refill request. If you follow up with the pharmacy (and I recommend it), and they still haven’t gotten new refills, check with your prescriber again. The point is you don’t want to start your sync plan and then have it thrown off because you didn’t have a refill.

Step 4: Start your plan

Gonna tell ya’, if you call my pharmacy with a sync plan and tell me you’re managing your refill sync and have a short fill to request, I’d probably have to be picked up. Then I’d probably give you a hug (and I’m not a hugger, just ask my crew). But I’ll still swear to it that the best synchronization I’ve ever ran across happened when the pharmacy and the patient worked together. So go for it. The key is to make sure that you pick up your short fills within a day or so of the fill and to stay on top of any needed refills. You own your meds and lean on the pharmacy to help get the refills and get them ready.

Let’s Run an Example

Since it helps to actually see something, lets run through an example for Bob. Bob is a typical diabetic with a small sack full of meds. We’re going to assume Bob did the legwork and figured out what his meds are for, got rid of all the crusty old bottles in his medicine cabinet, counted up what he has left, and came up with this list on 10/10:

Ok, so Bob is a little spread out here. We’ve got some 30-day prescriptions, some 90-day prescriptions, and a goofy 28-day prescription. Let’s dive in and see how to get good old Bob on track.

Step 1: Figure out a target date

First up let’s figure out what date is good to sync up. Rule of thumb: 28 days of supply will never equal 30 days of supply. You also cannot just “lose” 2 days every month. Ozempic is good. We don’t recommend messing with your injectable dosing. Now, if it’s a Vitamin D dosed once weekly, stretch it. But…ask your pharmacist first. So, when considering a target date, don’t look at anything that isn’t 30, 60, or 90. Bye bye Ozempic.

Now, gabapentin is treated as a controlled substance (or is a controlled substance in some states) by most pharmacies. Normally I’d say toss it out. The alternative, though, is to sync everything here to the gabapentin, since we only have the one “problem” child to deal with. So, let’s assume today is October 10th and you have 10 days of Gabapentin left (at three times a day dosing with 30 capsules remaining). You’re sync date, then, should be 10/20. We’re dealing with a mix of 30- and 90-day prescriptions, so we’re going to forecast out a few months.

Step 2: Figure Out Your Short Fills

Okay, so let’s see about some short fills. We’re going to get Bob to one day. It’s actually pretty easy but takes some thinking. Now, pay attention to the drugs that have superscripts. We’ll talk about those in a minute. We’re going to assume everything can be done for 90 days except gabapentin (since its treated as a controlled substance) and sertraline (because typically antidepressants are not written for 90 days). Take the medication that has the longest time until due (that’s rosuvastatin) and see where it falls. In this case, rosuvastatin is close to 3 months out at 12/21. Trade secret: insurance will usually fill medications after you use 85% of them. We’re going to fill rosuvastatin on 12/19 and sync everything else to that.

The breakdown

Alright. Number crunching time. Grab a calendar or use a calculator on the computer to calculate the difference between two dates. One at a time:

• Chlorthalidone. Its due on 10/30. It is already written for 90 days and has refill for at least 90 days. You’re going to short fill it on 10/30 for 50 tablets.
• Metoprolol (1). Its due also on 10/30. It also has no refills. You need to make sure you have a refill available by asking the pharmacy to reach out to the prescriber. Stay on them like white on rice. Then fill it for 50 days (or 100 tablets) on 10/30.
• Januvia (2). Its due real soon. Like 5 days. Fun fact: most states allow pharmacies to automatically switch certain prescriptions to 90-day fills provided they have enough dosage units remaining. Call the pharmacy and ask. If they can’t switch it or don’t have enough dosage units remaining, call your prescriber and ask for a 90-day. If you get that script in time, you want to fill 65 tablets on (10/15). Bob does, anyhow. Didn’t get 90 days? Fine. Fill 5 tablets on 10/15, then 30 on 10/20, 11/19, and so on.
• Metformin. Not due for a while but almost due on 12/19. Simple short fill of 20 tablets on 12/14 to get you through 12/19.
• Rosuvastatin. Like I said, most insurance companies allow a fill after 85% of the medication is utilized. We’ll do a full fill of 90 tablets on 12/19. No short fill required.
• Lisinopril. Due 11/2 for 47 tablets.
• Gabapentin. We’re syncing to a date that is beneficial to pick all meds up. Additionally, it’s a pain in the butt to get a prescriber to write a short fill for something that is a controlled substance in many states. So, no short fill here. Fill on 10/20.
• Sertraline. Bob’s gonna need 2 tablets on 10/18. Withdrawals from sertraline are crap, so just do it. Then fill 30 tablets with the Gabapentin on 10/20, 11/19, 12/19, and so on.

Finally, Bob should be able to fill all of his medications on or around 12/19. He’ll continue to get any 30-day fills monthly at the same time, and his 90-day fills will start lining up quarterly with his 30-day fills.

Step 4: Get Engaged

Lastly, Bob has to stay on top of it. He can let the pharmacy put him on auto refill or their sync program. I recommend it, in fact. Most of the time the pharmacy will go ahead and send off a refill request for expired prescriptions ahead of time. Likewise, many pharmacies will not stock high-cost medications ahead of when they need them, so an auto refill program will order those medications a day or two before they’re needed.

Importantly, Bob is going to also make sure he is taking all of his medications as prescribed. If he starts accumulating extra medication, there is a problem. If Bob stuck to the plan, he is missing doses or not picking up medication on schedule. Either way, a problem exists that needs to be dealt with. Again, speaking from 11 years of experience, the problem is not usually the pharmacy. We count 80,000-100,000 prescriptions a year. If you are accumulating medication on all your medications, I can just about guarantee it’s not us, it’s you. You’re throwing away money by missing doses. Refill synchronization is a two-way street and requires you (the patient) to remain engaged in your healthcare, and it also requires your pharmacy to be engaged and cooperative with you.

Next steps

The secret to refill synchronization is no secret. It just takes a little work. Need help? Ask your pharmacist. Can’t ask your pharmacist? Ask me; just use the messaging feature of the website and I’ll get back to you. Then I’ll say go slap your pharmacist ’cause he or she should always be willing to sit down and help.

Author: Zack

Pharmacist, tech guy, pianist, lover of beer, gamer, beach bum. Probably missed something. Just assume I'm into a little bit of everything.