How Will This Toolkit Help Me?
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
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.
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.
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.
Box Section Ref ID
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.
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:
Annual Prescription Renewal: Implementation Checklist (48 KB)
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:
Measure the Impact of the Annual Prescription Renewal Process (93 KB) Box Section Ref ID
Graphic Jump Location
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.
Journal Articles and Other Publications
Sinsky CA, Rule A, Cohen G, et al. Metrics for assessing physician activity using electronic health record log data. J Am Med Inform Assoc. 2020;27(4):639-643. doi:10.1093/jamia/ocz223
Farland B, Presutti J, Crowe S. Management of non-controlled prescription renewals in a primary care practice. American Association for Physician Leadership. November 29, 2019. Accessed December 1, 2021. https://www.physicianleaders.org/news/management-prescription-renewals
Pattin AJ, Devore N, Fowler J, Weldy D. An examination of the prescription renewal process and implications for primary care physicians and community pharmacists. J Pharm Pract. 2020;33(2):187-191. doi:10.1177/0897190018799217
Nelson SD, Rector HH, Brashear D, et al. Rebuilding the standing prescription renewal orders. Appl Clin Inform. 2019;10(1):77-86. doi:10.1055/s-0038-1675813
Doshi JA, Lim R, Li P, et al. Synchronized prescription refills and medication adherence: a retrospective claims analysis. Am J Manag Care. 2017;23(2):98-104. https://www.ajmc.com/view/synchronized-prescription-refills-and-medication-adherence-a-retrospective-claims-analysis
Neuner JM, Fergestrom N, Laud PW, Pezzin L. Factors influencing prescription drug synchronization: the complex role of number of medications. J Manag Care Spec Pharm. 2019;25(6):714-718. doi:10.18553/jmcp.2019.25.6.714