Your GPS for Multiple Prescription Benefit Coverages

Millions of U.S. patients have prescription benefit coverage with more than one health plan. Ample coverage is good, but it’s tough for prescribers and pharmacists to know where to turn when providing care for patients with multiple coverages. 

Why isn’t this medication covered? Why does it require prior authorization? Which formulary should I be using?  

These questions can make it difficult to get medications in the hands of patients who have prescription benefit coverage at more than one health plan. According to a U.S. Census Bureau report, about 43 million people in the United States had multiple health plans in 2021, and people 65 or older were more likely to have multiple coverages. 

Multiple prescription benefit coverages can make prescribing an exercise in guesswork, a matter of trial and error, and a source of confusion, friction and delay for all players involved in the process. 

Primary Coverage Indicator Is Your GPS 

With two or even three sources of prescription benefit coverage, selecting the right payer is like facing a fork in the road with no cellphone signal and no GPS. You can go left. You can go right. You could keep on going straight.   

But are you heading in the right direction?      

As a feature within our Eligibility solution, primary coverage indicator simplifies the selection process for prescribers and pharmacists when requesting coverage information. 

Already, the feature has made a substantial impact on our network. 

Since its full release in early 2023, we’ve processed more than 420 million multiple coverage eligibility transactions, and we’ve cut the erroneous selection of secondary Medicaid plans by 12%. 

How It Works 

Primary coverage indicator identifies the patient’s primary prescription coverage and ranks multiple coverages in the proper order. This prioritized view enables providers to easily choose the patient’s primary coverage at the point of care. 

• Prescribers send prior authorization requests to the right payer the first time.  
• Pharmacists see primary coverage and adjudicate claims without hassle. 
• Payers’ members are prescribed on-formulary medications. 

The right coverage information prioritized up front has positive cascading effects on the entire prescribing process. Prescribers and pharmacists know exactly where to turn, and patients can get their medications without delay.