As healthcare costs soar and the demand for solutions to move the needle on drug cost savings, accurate, succinct, and efficient drug prescribing is more critical than ever. Health plans face immense pressure to manage expenses while ensuring patients receive the right medications at the right cost.

Providers not only have to practice medicine but also be cognizant of a patient’s healthcare benefits. Making healthcare more efficient by having timely and actionable data is critical to all stakeholders, leading to lower costs for all.

Providers need to spend less time on non-value add activities and have the power to select from optimal drug alternatives directly within their Electronic Health Record (EHR) workflows without requiring any additional steps or training.

Technology's rapid evolution and growing patient awareness are reshaping healthcare expectations. A key advancement has been the integration of enhanced prescription data within Electronic Health Records (EHRs) at the point of care, while industry solutions have fallen woefully short of expectations.

Benmedica is leading a transformation with next-generation, innovative solutions that streamline the prescribing process, improve drug selection accuracy, and enhance patient outcomes while dramatically reducing costs.

This article explores the challenges facing today's health plans and demonstrates the costs of waiting to enhance the existing prescribing data and EHR workflows with Benmedica’s seamless, proven capabilities. The solution requires no provider engagement or training to unleash substantial savings with proven results through the inherent adoption of providers. That said, the more support providers are offered, the greater the results will be.

The Challenges in Drug Prescribing

The challenges facing drug prescribing are mounting as health plans struggle to better control pharmacy costs. With new technology relying on outdated data and delivery methods, prescribing has become increasingly cumbersome for providers. Rising drug costs mean health plans are absorbing significant costs and patients too frequently have delayed or forgo critical medications.

According to a recent Surescripts study, “providers expressed that a perceived lack of accuracy and completeness of formulary and benefit information was the number one reason they did not heavily rely on the data when prescribing.” Despite this complaint, it is highly ironic that 87% of providers still found it useful. As a result, there is a grand opportunity to address the perceived gaps with a solution that can empower providers in an unprecedented way.

Lack of actionable prescription data not only threatens the financial sustainability of health plans but also impacts the effectiveness of patient care directly.

The Challenge

The Challenge

  • Escalating Drug Costs
  • Inefficiency in Prescribing
  • Poor Drug Adherence

Escalating Drug Costs and Financial Sustainability

One of the most significant hurdles in healthcare today is the rising cost of medications. As drug prices increase, they place enormous financial pressures on health plans and patients alike, threatening the sustainability of healthcare provisioning.

These escalating costs necessitate a new approach to drug management, ensuring that health plans can continue to provide accessible and affordable care for their members.

 

Inefficiencies in the Prescribing Process

The process of prescribing medication is often hampered by a lack of transparency, information, and efficiency. Health providers frequently encounter complex formularies and benefits information, making it challenging to make informed prescribing decisions. They may see dozens of patients each day, most with different formularies and plan designs.

This complexity leads to increased time spent on medication selection and high-cost medications being prescribed unnecessarily. Providers are increasingly encountering burnout, which could be in part due to the inefficiencies of the current process.

"Despite cost transparency regulations, prescribers may not see a drug price in their EHRs when prescribing. Even if they see a price, it is unlikely that they will see a lower-cost alternative." - Fierce Healthcare

 

The Impact of Poor Medication Adherence

Inefficient prescribing processes are intricately linked to poor medication adherence, which poses severe risks to patient health and drives up overall healthcare costs.

“Lack of awareness about drug costs among physicians leads to prescription of more costly drugs when cheaper, equally beneficial, alternatives exist…Increasing out-of-pocket costs for patients results in decreased prescription adherence, especially among older adults” (NLM- “We need to mandate drug cost transparency on electronic medical records”)

Without access to comprehensive and accurate drug information along with therapeutically similar lowest-cost drug alternatives at the point of care, patients face delays and potential errors in receiving their medications, which can lead to higher costs for health plans with adverse health events and increased rates of hospitalization for members.

These issues not only inflate healthcare costs but also put patient lives at risk.

These pressing challenges underscore the urgent need for innovative solutions that can provide accurate and actionable drug information to healthcare providers at the point of care, enabling them to prescribe the most effective and cost-efficient medications for their patients. 

 

A Proven, Unprecedented Solution to Substantially Lower Drug Costs

It’s clear that traditional methods of managing drug prescribing and costs are no longer sufficient. The complexity of modern healthcare demands a revolutionary approach that not only addresses these challenges but also anticipates future needs.

Today’s advanced technologies and data analytics allow stakeholders to adopt unique solutions that enhance efficiency, improve patient outcomes, and improve financial performance.

The Limitations of Traditional Methods

Traditional approaches to healthcare have often focused on isolated solutions that address specific issues without considering the broader system. Looking at paper handouts, a third-party website, or even a mobile phone app is inefficient and problematic.

These methods are typically constrained by legacy processes and outdated technologies that are ill-equipped to handle the dynamic nature of today’s healthcare challenges. Providers cannot be expected to take extra steps in their prescribing workflow to deliver optimal results.

A new Point-of-Care Partners White Paper notes, “Health providers frequently encounter complex formularies and benefits information, making it challenging to make informed prescribing decisions. This complexity leads to increased time spent on medication selection and can contribute to provider burnout.”

The complexities of modern prescribing require a new approach—one that integrates the right data with current Electronic Health Record capabilities. This approach should consider the initial drug selection, patient needs, and ongoing adherence. 

According to the white paper, "New innovations focused on enhancing the medication alternatives list take ePrescribing to the next level by providing options that are clinically similar and more affordable, avoiding time-consuming and frustrating guesswork by the provider, and back-and-forth communications between the provider and the pharmacy.”

Ironically, there is a better solution that can implemented based on existing technology that’s already integrated in the provider’s workflow.

Benmedica's Next Generation, Layered Solution

In response to the multifaceted challenges within the healthcare industry, Benmedica has developed a comprehensive, layered solution approach designed to optimize the drug prescribing process. For the first time, Benmedica leverages precision formulary and benefit information to guide therapeutically similar, lowest-cost drug alternatives, which can then deliver the most optimal real-time prescription benefit information.

This approach leverages advanced technologies and seamless delivery within existing healthcare system EHRs without integration to ensure that providers can make informed, efficient, and effective decisions at the point of care.

Precision F&B™: Robust Formulary & Benefit Support

The foundation of Benmedica’s solution stack is Precision F&B™, which provides robust Formulary & Benefit support directly within Electronic Health Records (EHRs).

This system offers up to date, accurate and succinct formulary status and copay information, enabling healthcare providers to access critical data at the point of care.

By delivering this essential information seamlessly within the provider workflow without any additional clicks or hovers, Precision F&B™ ensures that prescribing decisions are both financially prudent and clinically appropriate.

This not only streamlines the prescribing process but also enhances the transparency needed to navigate the complexities of modern healthcare. When layered with value-based contracts, the savings become even more compelling when the provider also benefits even more from smarter decisions.

 

SmartAlts®: Intelligent Drug Alternatives

Building upon the robust foundation provided by Precision F&B™, Benmedica offers SmartAlts®, a system that layers on a selection of therapeutically similar drug alternatives guided by the detailed data from the F&B module.

SmartAlts® offers providers a concise and therapeutically similar list of alternatives, allowing for quick comparison and informed decision-making.

This tool simplifies the process of finding the most effective and cost-efficient medication options, thereby reducing the time providers spend on medication selection and minimizing the potential for burnout.

 

Intelligent RTPB™: Enhanced Real-Time Prescription Benefits

The culmination of Benmedica’s layered solution approach is the Intelligent RTPB™ system solution, which optimizes Real-Time Prescription Benefits (RTPB) by utilizing the enriched data gathered from the previous layers.

Standard RTPB “services provided by pharmacy benefit managers fall short of empowering cost-effective prescribing by failing to show the total cost of drugs and by failing to regularly deliver lower-cost alternatives.”(Fierce Healthcare – Bringning drug price cost transparency directly to patients.)

Intelligent RTPB™ enhances traditional RTPB systems by providing more comprehensive and actionable information, including detailed coverage restrictions, copay amounts, and eligibility requirements. The RTPB information is driven by Benmedica’s precision formulary and benefit information and smart therapeutically similar, lowest-cost drug alternatives to guide the most optimal RTPB result.

Benmedica’s Intelligent RTPB™ aims to bridge gaps by delivering crucial information in real time. This enables healthcare providers to make the most informed decisions possible, aligning patient care with financial sustainability and regulatory compliance.

By integrating these advanced tools—Precision F&B™, SmartAlts®, and Intelligent RTPB™ —Benmedica not only addresses the fundamental problems in drug prescribing but also sets a new standard for efficiency, transparency, and patient-centered care in the healthcare industry. 

This layered approach ensures that every step in the medication management process is informed by reliable, precise, and actionable data, ultimately leading to better health outcomes and optimized cost management.

Benmedica’s Proven Health Plan Shared Savings Success

A recent partnership with a major health plan demonstrates the power of Benmedica’s solutions.

From May to December 2023, Benmedica implemented its advanced prescription tools for a major health plan across 29 states, serving 12.5 million members and engaging over 2 million ePrescribers.

 

Overview of Savings

  • Time Period: May – Dec 2023
  • Total Members: 12.5M
  • Deployment: Across 29 US States
  • Providers: 2M+ ePrescribers
  • Initial Go-Live: May 1, 2023

Significant Financial Impact

  • During this period, Benmedica delivered substantial financial benefits:
  • Average Monthly Savings: $11.5M
  • Total Savings: $90M
  • Annualized Incremental Drug Savings: Over $135M

Per Member Per Year (PMPY) Savings

  • Commercial: $22.32
  • Exchange: $16.20
  • Medicaid: $9.12

The Benmedica Advantage

Benmedica stands out in the healthcare technology sector by offering solutions that not only meet the current demands of the industry but also set new standards for innovation and efficiency.

The Benmedica advantage is rooted in its comprehensive understanding of e-prescribing and approach to drug prescribing and management, highlighted by several key features that distinguish it in the marketplace.

 

Industry-Leading Coverage of Therapeutic Alternatives

Benmedica provides industry-leading coverage of therapeutic alternatives, ensuring that healthcare providers can access a wide range of medication options. Its SmartAlts® are reviewed by a full-time clinical pharmacy experts dedicated to managing its proprietary alternatives.

Benmedica also has a dedicated pharmacy and therapeutics (P&T) committee of pharmacists and physicians that meets regularly to conduct thorough reviews.

This extensive coverage (over 94% of paid claims) enables providers to see and select the most effective and cost-efficient medications tailored to their patients’ specific needs. By offering a diverse array of alternatives, Benmedica ensures that treatment plans are not only effective but also adaptable to various patient conditions and preferences.

 

Seamless EHR Integration to Empower Provider Decisions

A cornerstone of Benmedica's approach is its seamless integration with Electronic Health Records (EHRs) embedded within existing workflows without requiring any integration. This is crucial for empowering healthcare providers to make informed decisions without disrupting their workflow without any additional clicks, hovers, or applications. 

By embedding critical drug information and therapeutic alternatives directly into the EHR systems user interfaces, Benmedica minimizes the cognitive load on providers, allowing them to focus more on patient care rather than administrative tasks.

 

Detailed and Enriched Formulary & Benefit Information

Benmedica's solutions provide detailed and enriched Formulary & Benefit information, which is vital for transparent and informed prescribing. 

This level of detail ensures that healthcare providers can understand the full scope of patient benefits and medication costs, facilitating more informed choices that align with both clinical needs and financial considerations. 

The availability of comprehensive drug information is essential for optimizing drug spending and improving therapeutic outcomes.

 

A Multi-Channel Approach That Supports Clinicians Across Prescribing Scenarios

Benmedica adopts a multi-channel approach to support clinicians across a variety of prescribing scenarios. Whether in hospital settings, outpatient clinics, or remote care environments, Benmedica’s tools are designed to be versatile and effective across all platforms. 

This adaptability is crucial for meeting the diverse needs of today’s healthcare providers and patients, ensuring that regardless of the scenario, the quality of care and efficiency of service remain consistent.

By fostering a more transparent, efficient, and patient-centered prescribing process, health plans can significantly enhance their operational effectiveness and service quality.

Ready to generate savings and improve patient outcomes? Click here to learn more or request a demo.