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Real Time Prescription Benefit

Real-Time Prescription Benefit embeds patient-specific benefit information into the prescribing workflow. Bringing actionable intelligence to the point of care gives you access to up-to-date benefit details, price information and viable alternatives.

With true prescription price transparency, informing their decisions, physicians will be empowered to prescribe the exact right prescription, leaving patients confident in the cost of their therapy and more likely to adhere to it.

How it works

Real-Time Prescription Benefit delivers actionable patient intelligence through a simple process within the EHR workflow.
RTPB Workflow

You will have cost, source and supply options at your fingertips from the very first conversation, letting you offer the patients a transparent view into price implications. After agreeing with the patient on the exact right medication, you will write the prescription and electronically send it to the pharmacy.

Plus, our solution indicates whether a prior authorization is required, giving you the power to choose an alternative therapy and avoid the prior authorization process altogether. The patient will visit the pharmacy, pick up her prescription, and pay the amount she is expecting. No stress. No obstacles to successful adherence.

Advantages

  • A single connection to the largest network of PBMs and health plans
  • Real-time, direct prescription benefit and price information at the point of care
  • Patient-specific data — never estimated figures
  • Improved adherence and patient outcomes
  • Reduces callbacks and prior authorizations
  • Improves patient satisfaction in the care setting
  • Reduces patient time to therapy
  • Accelerates the prescribing process for providers

Example Usecase

RTPB Usecase

Work Flow in ChARM EHR

Step #1: Open an encounter or Quick Rx view.

Step #2: Start writing a prescription using the 'Add Rx' option. You can also add prescriptions to the chart note through other options like Templates, Past Rx, etc..

Step #3: Search your drug and prescribe
RTPB Search RX

Step #4: With RTPB feature enabled, selecting a prescription will show the formulary eligibility details of the prescription based on the patient's insurance plan details.
RTPB Choose PBM

Step #5: Choosing an insurance plan takes you to the prescription view.

Step #6: Enter the script details per your normal prescription workflow and select the pharmacy.

Step #7: Once the days-supply, quantity, dispensing unit, and pharmacy are provided, patient-specific estimated cost and benefit data are pulled from PBM and displayed on the right side of the view.
RTPB Pricing Details

'Pricing Details In Pharmacy' section displays the estimated pricing in the chosen pharmacy and other types of pharmacies with their pricing comparison. For example, If the requested pharmacy is retail and the medication is available at the requested retail, then the PBM will show retail pricing and may also show pricing at specialty mail. Coverage factors like Prior Auth requirement can be viewed on clicking Coverage link against each pharmacy type.

If the PBM suggests any clinically approved alternatives for the given medication, alternatives will get listed along with the pharmacy types. Estimated pricing and coverage details of the alternative prescriptions and pharmacies can be seen in this view.

Based on your clinical guidance and a discussion with the patient, you decide to prescribe the same drug or change to an alternate drug to a cost-effective pharmacy. 'Change' buttons in the pricing list view will be used to change the drug/pharmacy details.
RTPB Change Health Plan

Changing with alternatives will pick the corresponding alternative as prescribing drugs. The final prescription can be added, signed and transmitted electronically.

Check RTPB details for another Insurance Plan

If the patient has multiple health insurance plans and wants to check the pricing benefit for another plan, the insurance plan can be changed from the Add Prescription view using the 'Change Health Plan' link at the top of the view, next to 'Benefit Plan'.
RTPB Change Health Plan

This action will take us to a formulary view to change the insurance plan. Changing insurance plans and proceeding will once again call the RTPB request to get pricing details for the chosen health plan with the other prescription details. This process will again follow the same work-flow as defined in the above section (#RTPB Work Flow in ChARM EHR).

RTPB Supported PBMs

Currently, RTPB service is being supported by below PBMs. If the patient's PBM fall under any of these PBMs, pricing details will be available on prescription.

  • CVS
  • Express Scripts
  • DST & Cigna
  • DST - BSCA (Gemini)
  • Navitus
  • BCBS NJ (Gemini)