Expanding Visibility of Patients’ Benefits at the Point-of-Prescribing

All too often a patient brings a prescription to the pharmacy counter only to find out that the particular medication is not covered by their insurance. While the pharmacist can work directly with the prescriber to find an effective alternative for the patient or gain necessary approvals from both the insurer and physician to dispense the drug, this can be time-consuming, not to mention frustrating for prescribers, patients, and pharmacists. In addition, it can even delay the start of an important therapy, which can have an impact on patient health outcomes.

In this digital age, technology can help prescribers gain important visibility into the patient’s drug benefits, in real time and at the point-of-prescribing. In fact, at CVS Health, we are working with Epic, the most used electronic health record (EHR) in the U.S., on enabling a capability which would allow a prescriber to view a patient’s drug benefit during an office visit via the patient’s electronic health record (EHR). This helps the prescriber understand what drugs are covered by the patient’s insurance, the out-of-pocket cost to the patient for the drug, and if there are other preferred drugs the patient can fill at a lower cost – all before the patient leaves their doctor’s office. In addition, prescribers will also know if the drug they are recommending requires additional approvals – known as a prior authorization – and if so, they can start that electronically, which helps streamline the administrative process and cuts down on the claim approval timeline.

This type of point-of-prescribing visibility is critical to help bolster prescription decision-making for patients and their care teams, including physicians, pharmacists and health insurers; and in addition, can help avoid delays in patients’ access to their treatments and automate the prior authorization process.

Additionally, this strategic initiative will also leverage enhanced analytics and data sharing to improve integration across the health care system. This includes use of Epic’s Healthy Planet population health and analytics platform to generate insights surrounding medication dispensing patterns and behaviors around medication adherence as well as the development of a comprehensive clinical database to enhance medication counseling and help improve prescribing decisions for CVS Health patients.

Altogether, this initiative will translate into a better experience for the patient, the prescriber and the pharmacist, which can result in improved quality of care, better patient outcomes and lower health care costs for payors and patients.

For more information about CVS Health’s efforts to improve pharmacy care, visit our Health Care Delivery & Innovation information center. And to stay informed about the most talked-about topics in health care, register for content alerts and our bi-weekly health care newsletter.

10.16.17