This guest blog is one in a series by sponsors of the PQA Annual Meeting on improving patient outcomes through pharmacy models. PQA does not endorse, recommend or favor any product, service or organization that is a sponsor.

The Challenge of Polypharmacy and Nonadherence
As patients age, chronic health conditions tend to accumulate, leading to polypharmacy. Polypharmacy is the use of multiple medications to manage complex patient needs. Each additional prescription increases the risk of medication nonadherence, which can result in worsened clinical outcomes and higher healthcare costs. ^1,2 These costs come from both direct sources (e.g., hospitalizations, emergency visits) and indirect sources (e.g., lost productivity, disease complications).

Why The Appointment-Based Model/Medication Synchronization Works
Compared to simple adherence-improving interventions such as telephone reminders or automated refills, medication synchronization and associated interventions comprising the appointment-based model (ABM) have demonstrated high effectiveness.³

With ABM, pharmacies coordinate all of a patient’s chronic medications to be refilled on the same day each month, creating a dedicated appointment for medication pickup. This approach offers multiple advantages:

• Comprehensive medication reviews before the patient’s visit
• Identification and resolution of drug-related problems before dispensing
• Opportunities to address immunizations and adherence counseling during the visit

While the benefits to adherence with the ABM were well-known, economic impacts, such as total cost of care, were not previously measured. Pfizer partnered with a large community pharmacy chain and a payer to investigate claims data to evaluate the clinical and economic impact of ABM.⁴

Key Study Findings: Total Cost of Care of Medicare Advantage Beneficiaries Participating in an Appointment-Based Model in a National Pharmacy Chain⁴
When comparing patients on ABM to those receiving traditional care, both financial and medical benefits were observed, particularly in the first six months of patient enrollment into the ABM program:

• Reduced total cost of care, largely driven by lower monthly pharmacy spending
• Improved adherence rates, with more patients maintaining >80% adherence

Patients with multiple comorbidities benefited the most, achieving greater cost savings. This effect may be tied to the resolution of duplicative or unnecessary therapies. Implementing and maintaining a well-structured ABM program requires time, workflow changes, and staff engagement. However, the short-term improvements in care quality and cost reductions make ABM an important model for pharmacies seeking to optimize patient outcomes.

Overcoming Implementation Challenges/Future Visions for ABM
While ABM offers clear benefits evidenced by multiple years of positive data, implementation challenges remain. The services offered during the appointment of the ABM can be highly variable from pharmacy to pharmacy. There continues to be a lack of standardization and definition of pharmacist’s services that occur during the appointment. This leads to low payer recognition and reimbursement for pharmacist services, impacting the longevity and sustainability of these programs. The opportunity remains to continue to explore community pharmacy models and reshape these models for the current healthcare environment. What is the next iteration of the ABM? There is a need to further define what “the appointment” is and create new standardized services that close gaps in care. Ideally, there should be the same level of care from pharmacy to pharmacy that can be scaled and recognized by payers as a standardized service. ABM 2.0 is yet to be defined, but pharmacy must take the lead in shaping these standards. Now is the time to align, innovate, and advocate so that pharmacy is not only part of conversation, but driving the future of value-based care.

References:
1. Marcum ZA, Gellad WF. Medication adherence to multidrug regimens. Clin Geriatr Med. 2012;28(2):287–300. https://doi.org/10.1016/j.cger.2012.01.008
2. Cutler RL, Fernandez-Llimos F, Frommer M, Benrimoj C, Garcia-Cardenas V. Economic impact of medication non-adherence by disease groups: a systematic review. BMJ
Open. 2018;8(1):e016982. https://doi.org/10.1136/bmjopen-2017-016982
3. Nsiah I, Imeri H, Jones AC, Bentley JP, Barnard M, Kang M. The impact of medication synchronization programs on medication adherence: a meta-analysis. J Am Pharm Assoc. 2021;61;e202-e211. https://doi.org/10.1016/j.japh.2021.02.005
4. Luder H, Lawrence J, Musich S, Friderici J, Andrade K, Reed C, Ren J, Halpern R. Total cost of care of Medicare Advantage beneficiaries participating in an appointment-based model in a national pharmacy chain. J Manag Care Spec Pharm. 2024;30(8):782-91. https://doi.org/10.18553/jmcp.2024.30.8.782

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All rights reserved. October 2025