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Workflow and Process

Annual Prescription RenewalSave Time and Improve Medication Adherence

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Learning Objectives
1. Summarize the process of annual synchronized prescription renewal
2. Identify advantages of utilizing annual synchronized prescription renewal
3. Describe the 3 key STEPS to effectively implement the annual synchronized prescription renewal process

0.5 Credit CME

AMA STEPS Forward

Published Online: October 23, 2014

Team-Based Learning

Activity Information and Disclosures

Christine A. Sinsky, MD, MACP^a

Author Affiliations

^aVice President, Professional Satisfaction, American Medical Association

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How Will This Toolkit Help Me?

Learning Objectives

Summarize the process of annual synchronized prescription renewal
Identify advantages of utilizing annual synchronized prescription renewal
Describe the 3 key STEPS to effectively implement the annual synchronized prescription renewal process

Introduction

Annual prescription renewal refers to the process of renewing all of a patient's long-term medications once per year, for a duration of 12 to 15 months. Synchronized prescription renewal refers to the process of renewing all of a patient's long-term medications on the same date, resulting in fewer trips to the pharmacy, reduced risk of duplicate medications, and a lower likelihood of running out of medications. Ideally, both these processes occur, resulting in annual synchronized prescription renewal, which saves significant time for physicians and costs for practices.¹^- 3 Importantly, the frequency of patients' routine follow-up visits (eg, every 3 or 6 months) does not change when implementing annual synchronized prescription renewals.

How Much Time and Money Can You Save With Annual Synchronized Prescription Renewal?

Use this calculator to estimate the amount of time and money you could save each year by implementing an annual synchronized prescription renewal process in your practice. Calculations are for demonstration purposes only. Actual savings may vary.

Q&A

How much time and money per year will an annual synchronized prescription renewal process save my practice?
Consider a hypothetical scenario of an internal medicine practice that has not implemented an annual synchronized prescription renewal process. This practice has 1000 patients with chronic illness, with an average of 5 medications per patient. Every year, each patient makes an average of 2 calls per prescription. Each call lasts about 2 minutes. These factors result in more than 300 hours of physician and team member time spent on prescription renewals per year.

Three STEPS to Implement Annual Synchronized Prescription Renewals

Renew Prescriptions for the Maximum Duration Allowed By State Law
Synchronize All Prescriptions for Chronic Conditions to Be Renewed During One Yearly Visit
Include Instructions for the Pharmacy

STEP 1 Renew Prescriptions for the Maximum Duration Allowed By State Law

Quiz Ref IDStart by renewing all medications for chronic illness for the maximum duration allowed by state law. In most states, the maximum prescription duration is 12 to 15 months; a handful of states allow renewal for up to 24 months. Ideally, this renewal will occur via a synchronized process during the annual comprehensive care visit (see STEP 2). When patients receive prescriptions for their chronic conditions for a full year, they will not need to call the office for refills, and they will not have any unanticipated gaps in medication adherence.

Q&A

Should I only include patients seen once a year in the annual synchronized prescription renewal process?
Not necessarily. Patients are seen throughout the year as medically necessary. Medications are reviewed at each visit. Prescriptions may be modified and/or added. For consistency, prescriptions are written for 90 days with 4 refills. This way, you do not need to calculate the number of refills to last until the next annual comprehensive care visit because all prescriptions will be synchronized then.
How do I manage patients starting new medications that require close follow-up and/or modification, such as antihypertensives or antidepressants?
You are still following patients closely based on their medical needs. If their medication is modified, send a new prescription to the pharmacy along with a notification indicating that it replaces a previous prescription. No additional process is required if there are no changes and if the maximum number of refills were included in the initial prescription.
Suppose our practice uses prescription renewals as appointment reminders to encourage patients to come back for an interval visit. Will implementing an annual prescription renewal process lead to more “no shows”?
You can limit prescription refills to the number needed until the next appointment for the small subset of patients who do not comply with follow-up visits. Using an impending prescription expiration to encourage patients to keep their visits adds unnecessary work to a practice, contributes to patient and clinician stress, and often leads to medication non-adherence. Remember, do not let a few patients detract from a process that can benefit the majority.
What if pharmacies in my area don't honor prescriptions after 12 months?
Some states allow physicians to prescribe medications to last more than 1 year. If your state is not one of them, help patients “carry over” until their upcoming visit by scheduling their annual comprehensive care visit before the 1-year mark after the previous annual visit. This approach is the best way to minimize calls to the practice for medications in the interim. Setting up next year's annual appointment at the conclusion of this year's annual appointment can help.
Can I annually renew mail-order prescriptions?
Yes. Mail-order prescriptions should follow the same process as retail prescriptions.

STEP 2 Synchronize All Prescriptions for Chronic Conditions to Be Renewed During One Yearly Visit

Quiz Ref IDThe annual comprehensive care visit is an excellent time to renew all of a patient's long-term prescriptions because the medical history is thoroughly reviewed, including past and present conditions and medications.

During a busy workday, it may be tempting to renew only those medications that are due. However, renewing all prescriptions together and synchronizing the process reduces the subsequent number of calls for refills, saving significant time down the road. To do this, add a note to the pharmacist such as, “Renew these chronic meds for 1 year (90 x 4) and delete prior prescriptions for these meds. Please synchronize so they all come due the same day every 3 months.” Using a smartphrase will save even more time, so you don't need to write this for every patient.

A team-based approach to this process is recommended (eg, a refill nurse or medical assistant pends or prepares each renewal on the day of the annual visit). Streamlining this process eliminates the need to calculate the number of refills necessary to last the patient until the next annual visit. You can simply renew prescriptions for the maximum duration (ie, 90 days and 4 refills, or 90 x 4 in shorthand) to last the entire year.

Q&A

What happens if a medication has refills remaining at the time of the annual comprehensive care visit?
Having leftover refills does not change the approach. All prescriptions are renewed for the maximum duration whether they have refills left or not. A notation for the pharmacy that the new prescriptions replace the earlier prescriptions can be helpful. This is how all renewals become synchronized.
What happens if patients change pharmacies?
Pharmacies can often transfer prescriptions for non-controlled substances internally. The new pharmacy can then fill the remaining authorized refills. In many states, this process does not involve the physicians' office, and, if necessary, you can direct patients to coordinate prescription transfers themselves. If this is not possible, resending the medication may be necessary, but remember that this minority of patients will not counteract the overall time-saving benefits.
What about controlled substances?
You should not include prescriptions for controlled substances in the annual synchronized refill process. For tips on safely, effectively, and efficiently managing chronic pain, see the AMA STEPS Forward™ toolkit Essentials of Good Pain Care: A Team-Based Approach.

STEP 3 Include Instructions for the Pharmacy

Include instructions for the pharmacy on all prescription modifications and renewals as applicable. A standard notification indicating a medication discontinuation or a new dose replacing a previous one can accompany the electronic prescription submitted to the pharmacy. This notification allows the pharmacy to update the patient's current medication list, lessening the chance the patient will fill both the old and the new prescriptions.

You can also alert the pharmacy that the patient may not need to fill the renewed prescription right away to avoid dispensing the medication before the patient needs it.

Q&A

Quiz Ref IDWhat about new prescriptions? My patients hate throwing pills away, so I usually give a 1-month supply for a new prescription and then ask the patient to call us for a 90-day supply once they know they tolerate the medication.
We suggest you write the prescription for 90 days plus 4 refills and add a note, “Please fill 1-month supply first time.” Writing the prescription this way allows the patient to get a smaller number of pills on the first fill while precluding the need for an extra call or fax to your office.
Quiz Ref IDHow can we best handle off-cycle prescription renewal requests after implementing the annual synchronized renewal process?
It will take up to 1 year to get all your patients into the annual synchronized prescription renewal cycle. After this, every prescription renewal request that could be synchronized but wasn't can be seen as a breakdown in the process and presents an opportunity to improve it. Despite all efforts in the prescription renewal process, there will still be renewal requests, and it is essential to have a strategy for managing them. Therefore, it is still necessary to empower clinical team members to renew medications according to protocols and standing orders to reduce the physician's workload.

Conclusion

Quiz Ref IDAnnual synchronized prescription renewal can help your practice function more efficiently and save time. To put this approach into action, use the STEP-by-STEP guide provided in this toolkit and the corresponding implementation checklist:

Access Annual Prescription Renewal Implementation Checklist.

To understand the impact that synchronizing prescriptions can have on your practice, experiment with our interactive calculator, available in the Introduction section above and on its own page here, or check out this downloadable guide for a more comprehensive measurement and assessment approach:

Access Measure the Impact of the Annual Prescription Renewal Process.

AMA Pearls

At a dedicated annual comprehensive care visit, renew all medications for chronic illnesses for the maximum duration allowed by state law.
Use a team-based approach to prepare or pend annual prescription renewals.
Include instructions for the pharmacy to help with synchronization.

Resources

Annual Prescription Renewal: Implementation Checklist

(48 KB)

Measure the Impact of the Annual Prescription Renewal Process

(93 KB)

Article Information

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this enduring material activity for a maximum of 0.5 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships.

If applicable, all relevant financial relationships have been mitigated.

Credit Renewal Dates: February 2, 2018; April 25, 2019; April 24, 2022

Disclaimer: AMA STEPS Forward™ content is provided for informational purposes only, is believed to be current and accurate at the time of posting, and is not intended as, and should not be construed to be, legal, financial, medical, or consulting advice. Physicians and other users should seek competent legal, financial, medical, and consulting advice. AMA STEPS Forward™ content provides information on commercial products, processes, and services for informational purposes only. The AMA does not endorse or recommend any commercial products, processes, or services and mention of the same in AMA STEPS Forward™ content is not an endorsement or recommendation. The AMA hereby disclaims all express and implied warranties of any kind related to any third-party content or offering. The AMA expressly disclaims all liability for damages of any kind arising out of use, reference to, or reliance on AMA STEPS Forward™ content.

About the AMA Professional Satisfaction and Practice Sustainability Group: The AMA Professional Satisfaction and Practice Sustainability group is committed to making the patient–physician relationship more valued than paperwork, technology an asset and not a burden, and physician burnout a thing of the past. We are focused on improving—and setting a positive future path for—the operational, financial, and technological aspects of a physician's practice. To learn more, visit https://www.ama-assn.org/practice-management.

References:

Sinsky TA, Sinsky CA. A streamlined approach to prescription management. Fam Pract Manag. 2012;19(6):11–13. https://www.aafp.org/fpm/2012/1100/p11.html Google Scholar

Sinsky CA, Sinsky TA. Bundling prescription refills. Fam Pract Manag. 2013;20(1):9. https://www.aafp.org/fpm/2013/0100/p9.html Google Scholar

Doshi JA, Lim R, Li P, et al. A synchronized prescription refill program improved medication adherence. Health Aff (Millwood).2016;35(8):1504–1512. doi:10.1377/hlthaff.2015.1456 Google Scholar

Disclaimer: AMA STEPS Forward^® content is provided for informational purposes only, is believed to be current and accurate at the time of posting, and is not intended as, and should not be construed to be, legal, financial, medical, or consulting advice. Physicians and other users should seek competent legal, financial, medical, and consulting advice. AMA STEPS Forward^® content provides information on commercial products, processes, and services for informational purposes only. The AMA does not endorse or recommend any commercial products, processes, or services and mention of the same in AMA STEPS Forward^® content is not an endorsement or recommendation. The AMA hereby disclaims all express and implied warranties of any kind related to any third-party content or offering. The AMA expressly disclaims all liability for damages of any kind arising out of use, reference to, or reliance on AMA STEPS Forward^® content.

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