Audit Considerations for Med Sync Programs

Medication synchronization (med sync) programs are common across pharmacies and yield many benefits. Patients can request it to manage medication better and reduce the number of trips needed to the pharmacy. Patient adherence increases and pharmacies can keep tighter control over inventory while having more efficient workflow.

NCPA promotes the improved adherence and quality of care through med sync programs. They call it a “once a month appointment day” for patients enrolled, saying pharmacist-patient dialogue increases with more time to focus on additional patient care services.

NCPA collaborated with the Arkansas Pharmacists Association to conduct a study measuring the impact of med sync programs on medication adherence and persistence across 82 independently owned pharmacies. The workflow tool was provided to the pharmacies by PrescribeWellness operating on 13 pharmacy management systems. Over 8,000 patients enrolled for this year-long retrospective cohort study. The key findings state that med sync patients are over 2.5 times more likely to be adherent to medications and 21% less likely to discontinue drug therapy. For more details, see the Study Overview and Full Report.

It’s a win all around – until it poses a waste or abuse issue. PBM audit algorithms are made to seek out fraud, waste, and abuse. PBMs will flag pharmacies for audit if claims are billed particularly early every month; for example, every 23 days on a 30 day’s supply.

PAAS National® recommends …

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having patients opt in for med sync with a signature that can be produced under audit, ideally with annual reverification. This way the pharmacy has evidence to support the patient requested enrollment. This enrollment should also include guidance on how a patient may ‘opt-out’. Med sync best practices also include a phone call [preferably documented] every month to affirm the refills needed prior to dispensing. Cycling the refills at ≥ 90% utilization can also help lower your risk of audit triggers from PBM algorithms that look closer at 75% utilization. Avoid putting bulk items on med sync, such as inhalers, insulin, eye drops or topicals. Med sync also shouldn’t apply to prescriptions written for as needed purposes or controlled substances.

PAAS Tips:

  • State pharmacy regulations may prohibit automatic refill programs or require additional documentation
  • Payer restrictions may apply for programs such as Medicare Part B/D and Medicaid
  • Automatic mailing and delivery of prescriptions often have additional requirements
  • Read Getting in Sync from NCPA’s America’s Pharmacist February 2024
    • See also the Pharmacy Operations Manual for SimplifyMyMeds® from NCPA February 2018

Lindsay Doebert, CPhT
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