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.
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.
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.
While real-time pharmacy benefit checks are increasingly touted as the answer to formulary needs within Electronic Health Record systems (EHRs), prescribers and patients often require additional information to develop effective treatment plans. High-quality formulary and benefit data in the EHR can provide complete prescribing information without impacting provider workflow. Formulary and benefit data provides more detail than a single product real-time inquiry by offering comparative data across all products in a therapeutic area.