The Missing Gap to Drug Savings: Physician Understanding of Formulary and Benefit Information within EHRs

Providing doctors with education on how to use and interpret the formulary and benefit data provided in Electronic Health Records (EHRs) is an “untapped opportunity to help improve patient care and lower healthcare costs.” Benmedica understands how confusing formulary information can be in EHR systems and uses this knowledge to simplify and clarify information when upgrading formulary information for our clients.

Many physicians, deluged with onscreen alerts, messages, and text, are unaware that existing formulary and benefit data can offer them robust, actionable prescription information through their current EHRs. “Clinicians have completed years of school to master the ins and outs of care delivery; indeed, they are experts at providing healthcare. That expertise, however, doesn’t always extend to the technology they use in their workflow,” writes Jared Jeffrey, KLAS.

General physician perception of EHRs’ value is mixed. While most acknowledge the necessity of EHRs, 44% of physicians recently surveyed by Stanford Medicine’s annual poll view the primary value of EHRs as digital storage. Worse, nearly half believe that EHRs present more challenges than benefits.

This sentiment was echoed in a physician panel Benmedica hosted to discover how prescribers use their EHRs and what information they find valuable. The consensus was that today’s EHRs are cumbersome, difficult to navigate, and inefficient. 

Despite limitations, EHRs are still a valuable clinical tool for conveying coverage information to physicians during the prescribing process. Overcoming EHR challenges is a win-win for all parties involved: physicians save time, payers save money, and patients experience better outcomes. One solution to EHR inefficiencies is for payers to educate doctors on EHR use and optimize information provided to EHRs. 

A Triple Threat: Obstacles to Optimal EHR Use

Prescribers face three major obstacles to effective clinical use of EHRs: incomplete information, time investment, and meager training.

Incomplete Information

A significant barrier to physicians’ ability to effectively use EHRs to prescribe therapeutically appropriate, affordable medications is the dearth of actionable information present in most of today’s systems. While EHRs have the capabilities to display patient-specific prescription details like copay costs, equivalent alternatives, and preferred pharmacies, they lack the information needed to provide these details to doctors.

Physicians in Benmedica’s roundtable noted a lack of helpful information available to them in most EHR configurations. Many found tiers and formulary status confusing. They noted difficulty in accessing the information needed and gaps in existing information.

Without specifics like copay costs and affordable alternatives, physicians have to make educated guesses when selecting the best prescription for their patient’s medical and monetary situation.

"It is difficult for providers to have informed discussions with their patients that would help drive adherence when they don't have accurate visibility into prescription price information and available assistance programs," Healthcare Finance.

In response to this information gap, we founded Benmedica to assist payers and employers with enhancing formulary information so that doctors can find the best drugs for their patients.

While doctors are conditioned to prefer generics over brands, prescription costs are far more complex. Our overview of cost-saving tactics among generics provides several examples of significant cost variations between drug form, strength, and other properties. When doctors don’t have information on the drastic cost difference between prescription alternatives, they can’t select the option that will meet their patients’ needs.

By clearly communicating copay cost, alternatives information, and plan coverage restrictions, payers can make it easier for doctors to find the best prescription. And, when doctors prescribe drugs that are more cost-effective for their patients, plans save too (to the tune of about $88 per member per year).

Time Investment

Perhaps the single most frustrating factor of using EHRs for physicians is the time drain it places on them. Despite its early promise to save doctors time, working with EHRs consumes 5.9 hours per day of physician time (compared to 5.1 hours spent with patients).

EHRs have “required that physicians spend more and more time on tasks that don’t directly benefit patients.”

Many current electronic prescribing systems require doctors to make sense of general price indicators like formulary status and tier level without offering actionable information. Without patient-level information, doctors receive requests from patients and pharmacists to change prescriptions due to coverage and cost issues.

Spending time to find a prescription then rewriting it after receiving a request is just one burden EHRs place on physicians. Clumsy interfaces, hard-to-decipher information, and dated capabilities all contribute to poor user experience among EHR users. 

Meager Training

While better information is a large contributor to prescribers’ ability to select the best medication for their patients, skill at effectively leveraging ePrescribing technology is also critical for continued digital healthcare success.

After collecting and analyzing feedback from 72,000 healthcare professionals who use EHRs, researchers found that education was paramount to providers’ perception of the usefulness of the EHR system. “If health care organizations offered higher-quality educational opportunities for their care providers—and if providers were expected to develop greater mastery of EHR functionality—many of the current EHR challenges would be ameliorated.”

Physicians in Benmedica’s panel confirmed the researchers’ findings, noting that they received little to no training in how to find, understand, and use formulary and benefit information within their EHRs. 

Without adequate and ongoing training, physicians are not equipped to handle emerging capabilities such as Real Time Pharmacy Benefit (RTPB) checks. Positioned as a solution to EHR prescription inefficiencies and information gaps, in the current eRx landscape, RTPB may actually cause more problems than it solves unless doctors know how to use it effectively.

When asked about RTPB, doctors in our panel expressed frustration at its placement within their existing workflows and the amount of time an RTPB check would take. Added to these were concerns that proper training and support would be lacking, leaving physicians to figure out how to use this new capability on their own.


Payer Strategies for Improving Physician EHR Experience

While some fixes, like improving an EHR’s interface or streamlining the user experience, may increase physician satisfaction with electronic prescribing, many of these solutions are outside payers’ ability to change.

Payers can, however, improve physician use of EHRs in two significant ways: educating doctors and optimizing formulary and benefit information. Equipping EHRs with understandable information and arming physicians with the knowledge of where to find that information are critical for reducing prescription costs.

Educating Doctors

Investing in education for doctors is one available solution for payers. By supporting training for doctors on how to use their EHRs, they can more effectively find medications that are covered by patients’ plans and view lower-cost alternatives when appropriate. 

According to the 72,000-healthcare provider report cited above, “a greater focus on education and training is the overlooked opportunity that could enable EHR technology to drive substantial gains.”

The study also concluded that training is important for boosting physician confidence. “Without clearly understanding the EHR's limits or how to use the technology, care providers will not trust the technology they work with.” This trust is important to instill in doctors so that EHRs are used for more than digital storage.

Optimizing Formulary Information

Another solution is to improve the data sent to EHRs. When data is optimized for how doctors actually use it, they can understand critical prescription information without sifting through formulary gibberish or clicking through multiple screens to access cost indicators.

Ensuring that doctors can see actionable information, like prescription costs, preferred pharmacies, and therapeutically interchangeable alternatives within their EHRs is the best investment payers can make for reducing prescription costs. Formulary and benefit is displayed early in a provider’s workflow, during the drug selection process, versus after completing a prescription then running an RTPB transaction on one or more scripts.

Preparing Doctors for Successful EHR Encounters

When doctors have the right tools to access the right information, they can prescribe the best medications for their patients. Investing in EHR education and information optimization ultimately reduces payer costs and cultivates confidence among EHR users.

To learn more about Benmedica’s work in optimizing EHR information, visit our insights page or contact us.