A notable statistic emerged during a United Healthcare presentation at AMCP this past April regarding their PreCheck MyScript pilot:
22% of prescription decisions were influenced by real-time information
This occurred in the first 120 days of the service being active and included more than 1 million prescriptions. That’s at least 220,000 prescriptions that needed to be edited and the work fell to providers.
The Added Burden on Providers
It’s certainly better to make changes before the prescription is transmitted to the pharmacy versus having the pharmacy/provider/insurer handle avoidable administrative work after the prescription is sent. However, 22% is a very high percentage that requires a provider to go back to the original prescription(s) and change one or more elements like drug, strength, pharmacy, quantity, days supply, and/or the Sig.
While it’s a significant improvement to move the work from the pharmacy to the prescriber, can the information be moved further upstream to avoid potential rework? Prescribers are already under a lot of time pressure. They are critical in making prescribing decisions and their time needs to be better respected.
A Look at How Better Information within the EHR Leads to Better Prescriptions
With no formulary guidance, prescribers are picking drugs that they think are covered and low-cost. Typically they may see something like this with or without some formulary information:
At a minimum, providers should see formulary and benefit information like this:
This view is much more helpful since it provides formulary, copay tier, and some coverage information. From this information lower cost alternatives can be identified in the EHR. That said, could the prescription screen provide more information to ensure a clean, low-cost prescription for all stakeholders?
To minimize the chance of revisions a provider should be seeing something like the following during the prescription selection process:
This view provides patient copay, approximate drug cost, and relevant messaging. If insurers want to respect the provider’s time, then they will need to provide as much information as possible up front as part of the drug selection versus after the prescription is written.
Lowering the Bar: Why a 5% Prescription Modification Rate Makes Sense
If 22% of all prescriptions had to be modified, how long would providers be satisfied with this level of rework? Eventually it would become frustrating if not infuriating. Information on the last image represents a good implementation of the current formulary & benefit standard. It provides significant directional information so that the final prescription can be as clean as possible. Then the Real-Time Pharmacy Benefit (RTPB) transaction affirms the selection to ensure that any member-specific issues will not prevent the patient from receiving the prescription at the pharmacy. We believe that the percentage of prescriptions requiring changes should be much closer to 5%. That would make RTPBC less punitive and more of a risk-avoidance opportunity for providers and all other stakeholders.
The Value and Burden of RTPB – Real-Time Prescription Benefit Check Information
Real-time pharmacy benefit information benefits patients, pharmacists, and payers but adds burden to physicians. Patients benefit from selection of the most appropriate medication. Pharmacies benefit from more accurate prescriptions with fewer changes. Payers benefit from lower drug costs. Physicians, however, bear the burden of writing and rewriting prescriptions to satisfy patient needs, payer demands, and pharmacy changes.
The situation can be improved by providing physicians with better formulary data with appropriate alternatives upfront in the drug selection process. When physicians have access to better formulary information at the time of prescribing, they can select the right prescription at the right time. This ultimately leads to fewer prescription modifications and reduces the physician burden of rewriting prescriptions. Some payers are providing this improved data but many continue to include data that has room for improvement.
It’s worth it to all stakeholders to get the optimal, clean prescription every time.
How BenMedica Can Help
BenMedica assists health plans and payers with optimizing the data sent through Surescripts and other connections to EHRs for use by prescribers. Our process uses existing data to communicate relevant copay, formulary information, preferred alternatives, and custom messaging to physicians at the time of prescribing.
Contact us to learn more about our work.