Medication synchronization is the organization of a patients’ prescriptions so that all prescriptions can be filled on the same day each month. This process is convenient for the patient and should increase medication adherence for health plans. Previously, one of the biggest hurdles surrounding medication synchronization for pharmacies was how to bill prescriptions that were, essentially, early refills.

In May 2012, The National Council for Prescription Drug Programs (NCPDP) developed submission clarification codes to help meet the market needs surrounding synchronization. Two new submission clarification codes, one for “shortened days supply fill” and another for “fill subsequent to a shortened days supply fill” can be used to communicate clarifications from the pharmacy to the health plan regarding short-filled medications for the purpose of medication synchronization. The first code indicates that a medication is short-filled for the purpose of synchronization, and the second code can be used for the subsequent full refill of the medication to prevent “refill too soon” claims rejections. NCPDP has also developed a code that health plans can use to communicate with pharmacies. This newly approved message code identifies for the pharmacy that the prescription copay was pro-rated.

The new NCPDP codes were developed in response to a CMS requirement mandating that health plans administering Medicare Part D plans pro-rate co-pays associated with refill synchronization. This requirement goes into effect Jan. 1, 2014 and will offset Medicare Part D patients’ out-of-pocket expenses for synchronization. The same requirements are not in place for patients with commercial plans. However, that does not mean that plans do not support medication synchronization, but are able to decide whether to implement this functionality to support medication synchronization for their commercial members.