Physician Insights into Real-Time Pharmacy Benefit Information

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.


Real-time as a New Concept

Our roundtable physicians were not familiar with real-time pharmacy benefit capabilities.  As part of our discussion, we needed to provide a description and sample screens from their EHRs.  We also explained the source of the data and intended use.  None of this was apparent to the roundtable participants prior to our discussion—their comments were based on their impressions in the session.

The roundtable physicians indicated that there was a lack of training on formulary information in the EHR and that they anticipated similar issues with real-time pharmacy benefit information.  They said that this was typical of new information or capability rollouts in EHRs. Payers might have to help physicians understand new real-time information so that they can use it effectively.


Real-Time Pharmacy Benefit Information Disrupts the Workflow

Rewriting a prescription was repellant to the roundtable. The consensus was that the real-time pharmacy benefit is poorly located in the workflow. Having to write all or most of a prescription before seeing a response was a major drawback.  Entering the strength, patient instructions, quantity and selecting the pharmacy all add to the time burden on physicians if a prescription change is needed.  Most attendees indicated that they often write more than one prescription during an office visit, so the time burden is accordingly increased based on the number of prescriptions.


Alternatives in Real-Time Responses

Roundtable members, who had not yet seen real-time information in their own systems, were unsure of the value of running real-time checks to determine alternatives. Those that had access to alternatives as part of formulary data noted that alternatives were frequently either first-line therapies that were already prescribed to the patient or had been previously considered.  An example cited was a first-line generic as an alternative to a second-line, more expensive brand.

Viewing alternatives by non-equivalent strengths was also cited as an issue. Since starting dosing and strengths vary by medication, physicians anticipated needing to determine equivalent doses for each alternative. Relying on strengths in a real-time response could prove dangerous for the patient if the strength is not therapeutically equivalent.


Real-time in Use in an Accountable Care Organization (ACO)

The roundtable physicians that were part of a risk-sharing arrangement did see a potential advantage in being able to identify the total cost of the drug as part of their evaluation of alternatives during a visit. However, the process of completing a prescription for each drug and comparing responses manually to select the best option was seen as a significant burden.  The value in having patient and total drug cost was appealing to the panel, but they understood that this workload would not be something that is practical for every patient.


Pharmacy Networks

One area that intrigued our roundtable physicians was including the network pharmacy along with price.  A common cause of prescription changes is redirecting prescriptions to other in-network pharmacies.  Our panel noted that patients are often unaware of what pharmacies are in their networks and the savings in-network pharmacies offer. Redirecting prescriptions is particularly burdensome on physicians at the beginning of the year when many networks may change. Viewing this information through real-time transactions in the EHR helps physicians send prescriptions to in-network pharmacies the first time.


Physician Priorities

As we stated in our earlier article, the physicians we spoke to were primarily concerned with two things that could lead to pharmacy callbacks: saving the patient money and reducing prescription modifications. Real-time pharmacy benefit information is a step in the right direction but the roundtable physicians considered finding alternatives potentially cumbersome.  One physician told us that he sees 30-40 patients a day and writes 2-3 prescriptions per encounter.  Having to run a real-time pharmacy benefit inquiry for each patient to check multiple medications may take too much time to be helpful. For a prescription to be changed, it had to significantly reduce patient drug costs or avoid a callback.


A Way Forward: Benmedica’s SmartAlts™

Despite drawbacks to using real-time pharmacy benefit information, the physicians in our roundtable wanted access to this information. The good news is that EHRs have the capability to display better formulary information so that physicians choose the best drug the first time. Real-time pharmacy benefit transactions can then be used to confirm their selection rather than drive it.

Health plans can overcome the challenges of running real-time benefit checks by offering better formulary and alternatives information. Benmedica’s SmartAlts™ capabilities help payers produce more relevant and useful alternatives within formulary and real-time pharmacy benefit information.

Contact us to learn more about Benmedica’s solutions.


Need to Gather Physician Insights for Your Plan?

We believe that all health plans would gain valuable insights from their own physician roundtables centered on EHR formulary and real-time benefit issues. Contact us for a complimentary copy of our question set and leader’s guide to use as a starting point for your own physician panel. 

We can also facilitate your roundtable to help you glean the insights needed on how your physicians perceive your formulary data in their EHRs and what obstacles must be overcome for money-saving outcomes.