BenMedica partners with Health Plans, Risk-Sharing Entities (like Accountable Care Organizations), Employers, Government Agencies and Pharmacy Benefit Managers (PBMs) to provide more complete information to clinicians at the point-of-prescribing. When physicians have access to specific information such as copay, alternatives, and coverage restrictions, they are able to prescribe covered medications their patients can afford. This increases the use of preferred medications and in-network pharmacies, lowering drug spending for all stakeholders.

How We Help Health Plans

BenMedica’s solutions provide health plans with the tools and information needed to convey formulary, copay and coverage information effectively at the point of prescribing. By offering prescribers more complete information, they can select the best medications for their patients. This leads to increased medication adherence and decreased costs for disease management due to non-adherence.

Even for health plans that use PBMs, many prescribers only receive basic formulary information through their EHRs, leaving them without the necessary details to prescribe clinically effective drugs that patients can afford. Without access to robust formulary and benefit information, prescribers lose time selecting appropriate drug treatments, health plans pay for non-preferred prescriptions, and patients are more likely to abandon prescriptions they cannot afford.

PBM + Health Plan Formulary Data…Better Together

Traditional PBM information can be supplemented with more complete formulary and benefit data from a health plan. BenMedica can integrate data from PBMs with enriched secondary formulary data created for a specific health plan. By leveraging our proprietary systems and ePrescribing expertise, our team can work in conjunction with health plan staff to create more robust formulary data and improve prescribing decisions through better information.

Our ongoing participation in developing the National Council for Prescription Drug Programs (NCPDP) standards that govern how formulary data is created, transmitted, and displayed in EHRs is critical to supporting prescribers in making the smartest drug decisions for their patients.

How We Help Pharmacy Benefit Managers

BenMedica partners with PBMs to enhance the formulary data health plans send to prescribers through EHRs. By facilitating increased prescriber access to actionable information, PBMs can help health plans reduce spending on non-preferred prescriptions and out-of-network pharmacies.

With BenMedica your health plans may also improve their Healthcare Effectiveness Data and Information Set (HEDIS) and Medicare Part D Star Ratings, ultimately leading to higher reimbursement, better outcomes and lower costs for all stakeholders. 

BenMedica can assist PBMs with augmenting the following data through EHRs:

  • Copay information in the formulary at the time of prescribing

  • Restrictions on drug use customized to the health plan or group level

  • Alternatives for formulary information

  • Relevant messaging

PBMs partnering with BenMedica can have our systems create formulary data customization at the individual health plan or group level. The enriched data can be viewed and edited by PBM customers prior to distribution.

Getting Started with BenMedica

Visit our getting started page or contact us to learn more about how we can quickly and cost-effectively put our solutions to work for you.