Specialty Medications & Medical Benefit Drugs: The Value of Providing Physicians with Actionable Information at the Point-of-Prescribing

Specialty Medications & Medical Benefit Drugs: The Value of Providing Physicians with Actionable Information at the Point-of-Prescribing

Prescribing cost-effective specialty medications including those covered under a medical benefit requires physicians to have access to drug-specific information on plan coverage and restrictions. Currently, many physicians can only see that a medical benefit drug is not covered as part of the pharmacy benefit with no additional information.

3 Actions Health Plans Can Take Now to Improve Physician Prescribing and Lower Drug Costs

3 Actions Health Plans Can Take Now to Improve Physician Prescribing and Lower Drug Costs

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.

BenMedica’s Response to CMS’ Proposal to Lower Drug Prices and Reduce Out-of-Pocket Expenses

BenMedica’s Response to CMS’ Proposal to Lower Drug Prices and Reduce Out-of-Pocket Expenses

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.

Updates to the Formulary & Benefit Standard Create Changes for the Next Decade

Updates to the Formulary & Benefit Standard Create Changes for the Next Decade

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.

Indication-Based Formularies: A New Tool in Drug Cost Management

Indication-Based Formularies: A New Tool in Drug Cost Management

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).

Automating Alternatives Across a Formulary

Automating Alternatives Across a Formulary

Formulary and Benefit (F&B) data and Real-Time Pharmacy Benefit inquiries (RTPB) are a powerful combination that health plans and other payers can use to communicate preferred alternatives to prescribers through electronic health records (EHRs).

Providing Real-Time Pharmacy Benefit Information is Adding to the Physician Burden

Providing Real-Time Pharmacy Benefit Information is Adding to the Physician Burden

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.

Physician Insights into EHR Formulary Information Use

Physician Insights into EHR Formulary Information Use

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.