The Centers for Medicare and Medicaid (CMS) recently proposed a rule to adopt a transaction standard that would require Medicare Part D payers and prescribers to use electronic prior authorization (ePA) capabilities within their electronic health records (EHRs).
Health benefit consultants can help their clients save up to $88 per member per year on prescription spending by sending actionable drug data to doctors. By partnering with BenMedica, consultants can reduce their employers’ and members’ Rx costs, increase medication adherence, and improve patient outcomes.
Employers and health plans are missing significant prescription savings opportunities available today through improved formulary and benefit data. Enhancing patient benefit data leads to better information at the point of prescribing, improves drug cost management, and creates savings now for both payers and patients.
Providing actionable information on generics options to physicians using Formulary and Benefit (F&B) data creates significant savings for payers, employers, and consumers.
Physicians have been conditioned to prescribe generics as part of first-line therapies to save patients money and eliminate callbacks requesting prescription changes. But, not all generic prescribing is equal.
Prescribing cost-effective specialty medications including those covered under a medical benefit requires physicians to have access to drug-specific information on plan coverage and restrictions. Currently, many physicians can only see that a medical benefit drug is not covered as part of the pharmacy benefit with no additional information.
The CMS’ proposed rule requires Part D sponsors to integrate a real-time benefit tool (RTBT) within an electronic medical record (EMRs).
This proposed rule overlooks the option of offering enhanced Formulary and Benefit (F&B) as a solution for prescriber access to more complete drug benefit information.
Formulary and Benefit (F&B) data is central to providing prescribers using Electronic Health Record systems (EHRs) information from payers on drug coverage and formulary preferences. The National Council for Prescription Drug Programs (NCPDP) determines the standard, called Formulary & Benefit Standard, for exchanging the information electronically.