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Real-Time Prescription Benefit [WATCH VIDEO  ]

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 and informing their decisions, Physicians will be empowered to prescribe the exact right prescription, increasing the Patients’ confidence in the cost of their therapy and more likely to adhere to it.

How does it work?

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, allowing you to provide Patients with a transparent view of the price implications. After agreeing with the Patient on the exact right medication, you will write the prescription and send it electronically to the Pharmacy.

This solution indicates whether a prior authorization is required, gives you the power to choose an alternative therapy, and avoids the prior authorization process altogether. The Patients will visit the Pharmacy, pick up their prescription, and pay the amount they expect. No stress and obstacles to successful adherence.

Advantages

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

Example Use case

RTPB Usecase

Work Flow in Charm EHR

  • Open an Encounter or Quick Rx view.
  • The Patient benefits can be viewed using the 'Drug Eligibility' option.
    Drug Eligibility
  • The benefit details get pulled from PBMS through Surescripts.
    Eligibility Details
  • 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.
  • Search for the drug that you need to prescribe.
    RTPB Search RX
  • With the RTPB feature enabled, selecting a prescription will show the formulary eligibility details of the Prescription based on the Patient's insurance plan details. These eligibility details and medical pricing will be shown only to the Patients with prescription benefit plan coverage and if the benefit plan is a part of the Surescripts network alliance participant.
    RTPB Search RX Result
  • Reviewing the eligibility details takes you to the prescription view.
    RTPB Add RX
  • Enter the script details as per your normal prescription workflow and select the Pharmacy.
  • Once the days' supply, quantity, dispensing unit, and Pharmacy are provided, Patient-specific estimated cost and benefit data get pulled from PBM and displayed on the right side view.
    RTPB Pricing Details

The '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 the Prior-Auth requirement can be viewed by clicking the ‘Coverage’ option 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 can decide to prescribe the same drug or change an alternate drug to a cost-effective Pharmacy. The 'Change' buttons in the pricing list view will be used to change the Drug/Pharmacy details.
RTPB Change Health Plan

Changing with the 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 needs 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 the '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 workflow as defined in the above section (#RTPB Work Flow in Charm EHR).

RTPB Supported PBMs

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

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