Health plans that include approximate drug costs in cost-of-care-based calculations for prescriber payments or incentive payments need an effective way to communicate drug costs to prescribers in existing workflows. Delivering drug cost information in health plan formulary and benefit data through the prescriber’s Electronic Health Record (EHR) during a patient encounter capitalizes on existing technology, streamlines prescriber access to health plan information, and increases transparency.
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.
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.
Payers can use existing formulary data and EHR capabilities to satisfy physician and patient demand for timely copay information today. Upgrading formulary data to include better information enables physicians to make treatment decisions that patients can afford and are more likely to follow. Developing a plan for providing the right formulary and copay information is clear-cut and provides a long-term return on investment by boosting preferred prescription and pharmacy utilization rates.