Convenience and simplicity in healthcare are usually masking considerable complexities
Imagine this: You're at the doctor's office, and she is about to prescribe you medication but realizes you will save $73 if she prescribes a different (but on formulary) medication – so she does. And even though the medication needs prior authorization, it's already approved when you arrive at the pharmacy. With your medication in hand, you realize how easy this process was and are relieved that you didn't experience sticker shock or delays at the pharmacy counter.
Whether or not you've had this scenario play out in real life, this is the future of prescribing medications that is available today. But this convenience and simplicity are masking considerable complexities behind the scenes.
In a recent MGMA podcast episode, Neil Simon, Chief Technology Officer at eMDs, and a team from Surescripts discussed how we are able to go beyond the traditional notion of prescribing to get to this ideal scenario. The panelists explained that prescribing process should be seen as a sequence of steps that include systems and processes that accurately inform coverage, give options within the context of the coverage and plan design, assist in streamlining valuable next steps like prior authorizations, and even support collaboration between stakeholders through the dispensing journey.
Another component needed to enhance prescribing is making sure prescribers have access to the right information for the right purpose at the right time.
“There’s definitely a lot of area for growth both in how physicians look at and trust the data, as well as getting better and more accurate pricing information,” Simon explained. “We're not only working to get coverage information for patients who have insurance, but also patients that might not have prescription coverage, so they get that the best value for their medication.”
After twenty years of delivering true interoperability and information sharing, reducing complexity is something that Surescripts does well. Here are just a few ways our Enhance Prescribing solutions transform the prescription decision process and promote medication adherence.
Eligibility brings clear information about a patient's prescription benefit coverage into prescribing and pharmacy workflows.
Formulary gives the prescriber the ability to quickly get a plan-level understanding during the prescribing process if the medication is on formulary and if it needs prior authorization.
On-Demand Formulary delivers plan-level formulary information to prescriber workflows via real-time request/response transaction.
Real-Time Prescription Benefit gives clinicians patient-specific benefit and cost information at the point of care for the selected drug, the opportunity to avoid prior authorization, and options for therapeutic alternatives, helping them address cost concerns and boost adherence.
Electronic Prior Authorization connects health plans to electronic health records and pharmacy software so clinicians can quickly process prior authorizations and patients get their medication sooner.