Effective Use of Drug Alternatives to Improve Formulary Compliance and Reduce Drug Costs

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.


Figure 1: Sample EHR View without Formulary and Benefit Alternatives


Widespread use of EHRs allows for health plans to communicate alternatives to prescribers through existing infrastructure. Within nearly every EHR, Formulary and Benefit data is required to obtain government incentives for Meaningful Use. Certification for transmitting prescriptions through the Surescripts network requires EHRs to display drug alternatives included in Formulary and Benefit data by health plans.

Optimizing the use of Alternatives within Formulary and Benefit data offers health plans a valuable tool for communicating preferred alternatives to non-preferred drugs or drugs that are not covered. Health plans, as formulary publishers, are missing opportunities to better communicate with prescribers and improve formulary compliance for preferred formulary drugs.


Figure 2: Sample EHR View with Formulary and Benefit Alternatives

The Prescriber Dilemma

Prescribers need to make rapid decisions during patient visits. Prescribers often receive messages through their EHRs, during the prescription creation process, that selected medications are ‘non-preferred’ or ‘non-formulary’ but no information on preferred alternatives is included.  Choosing the best alternative becomes more complicated and time-consuming when the non-preferred drug has several similar drugs in the same class and prescribers must choose between multiple alternatives to find an affordable and clinically appropriate option.

Displaying the health plan’s preferred choice at the time a non-preferred drug appears saves prescribers time and increases formulary adherence.

Deciphering Options

Today, many formularies do not provide guidance on preferred prescription alternatives but they easily can.  Without any additional information the prescriber is left to a guess what a preferred product might be. To find covered alternatives for a non-preferred brand drug, the prescriber must manually select each drug option to see its formulary status or choose to send the non-preferred prescription to the pharmacy. This option will likely result in additional communication from the pharmacy and a delayed access to treatment for the patient.

If a prescriber encounters a drug with a prior authorization requirement, they may prefer to see if any alternatives do not require prior authorization.

Having the ability to quickly view all available alternatives including those that require prior authorization saves time and frustration on the prescriber’s part.

The limited time a prescriber has to input or update a treatment plan requires some additional guidance in the EHR for treatment decisions. Using Formulary and Benefit data in the EHR guides a prescriber during the visit, speeds the selection of a more formulary-compliant product, and allows more time for the prescriber to spend counseling the patient.


How Benmedica Can Help

Benmedica assists health plans and payers with optimizing the data sent through Surescripts to the EHRs for use by prescribers. Benmedica has deep experience developing processes to best leverage existing data to include alternatives in Formulary and Benefit data to reach prescribers at the time of ePrescribing.

If you are interested in learning more about the solutions Benmedica has to assist health plans with delivering the right information at the right time, please contact us or explore our solutions. For updates on our prescriber/EHR formulary optimization work, link with us on our LinkedIn page.


About Bruce

Bruce Wilkinson, the founder and CEO of Benmedica, has leveraged technology to facilitate healthcare since the birth of electronic prescribing and physician connectivity in 2002. Bruce has extensive industry experience through his time at Accenture, Express Scripts, ZixCorp, and CVS Health and continues to lead the development of healthcare standards through NCPDP. You can connect with Bruce on his LinkedIn page.