Synchronizing Refills – Missouri Pharmacy Adherence Month

By Kacee Blackwell, PharmD

What drives a patient to be adherent to his medications? What forces are involved which make him non-adherent? Perfectly adherent patients may simply be inclined to follow a routine in their everyday tasks and are, therefore, more likely to schedule medication use with their list of daily habits. Others may find that adding one more daily chore is impossible or even unnecessary. Often, it is a matter of convenience. The extra effort (time, transportation, or money) required to obtain prescription refills can be enough to limit a patients’ medication usage. As pharmacists, it is within our scope of practice to address each of these scenarios to improve the outcomes of our patients’ medication therapy.

Even those patients who want to be adherent may find themselves in a situation with more barriers to obtain their prescriptions than they are willing to overcome. Patients taking multiple prescriptions may have to make weekly trips to the pharmacy just to satisfy the requirements of “refill too soon” rejections. Others may end up waiting a couple of days for the prescriber’s approval for refills on a prescription that has run out. A great way for pharmacists to help their patients overcome this inconvenience hurdle is by synchronizing a patient’s entire prescription regimen to be refilled on the same day of the month. This requires some extra planning by the pharmacy staff, but ultimately promotes pharmacist-patient communication and patient loyalty, while reducing adherence barriers.

How do you start synchronizing refills? First, print a prescription history for your patient from the past six months. Take a good look at what gaps in therapy appear. Discuss these with your patient. Educate him/her on the importance of these medications. From your discussion with the patient and the days’ supply of each last-filled prescription, you should be able to determine what day each prescription is due next. From here you can find which date may be most appropriate for synchronizing all refills. It is likely that there will be some prescriptions that will need to have a “short-fill,” so that it will come due at the same time as the others.

This small step of added convenience means so much to patients whose lives are now made less stressful. One patient calls me her “little angel” for helping her keep up with her extensive regimen of diabetes, hypertension, and hyperlipidemia meds. Another patient says she wouldn’t know if she could make it without us helping take care of the multiple medications for her adult child with mental retardation. With a little extra effort to help improve adherence, we are making a difference in their lives.

Reprinted with permission from National Community Pharmacists Association in the December 2010 issue of America’s Pharmacist. For more information about NCPA, visit

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