Health plans who do not provide optimal Formulary and Benefit (F&B) information to prescribers through Electronic Health Records (EHRs) are missing a significant opportunity to lower medication costs and increase patient adherence to treatment.
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.
A recent announcement from the Centers for Medicare & Medicaid (CMS) has opened the door for Medicare Part D plans to use indication-based formularies beginning in 2020. This policy expansion provides a new tool for Part D plans to leverage costs and communicate formulary status to better inform prescribers and patients while solidifying what commercial payers may have been doing all along by using Prior Authorization (PA).
Recently BenMedica hosted a roundtable of physicians to share their perspectives on EHR formulary data. We were particularly interested in obtaining feedback on formulary data as it appears in EHRs (discussed in this article) and the value of real-time pharmacy benefit information in the EHR.
The following are the key takeaways from the roundtable regarding the new real-time pharmacy benefit information that will be appearing in EHR systems.
Recently we hosted a roundtable of physicians to share their perspectives on EHR formulary data. Our goal was to get a clear picture of how physicians use EHR formulary information when making prescription decisions. We were struck by the consistent responses physicians across specialties shared regarding what was helpful and the challenges they faced.
While health plans invest time and effort in negotiating contracts with pharmaceutical companies to improve affordability, they are missing the opportunity to increase the use of preferred alternative drugs. Formulary and Benefit data appears in the Electronic Health Record (EHR) at the time of prescribing and informs the prescriber about a drug’s formulary status. Often, this data does not indicate the plan’s preferred alternative drugs, leaving prescribers to use EHR generated results that are often too broad or even clinically inaccurate. This process is inefficient, wastes prescriber time, and does not maximize the use of preferred alternative drugs.