Small Improvements to Benefits Data Can Have a Positive Impact at the Point-of-Care

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ePrescribing offers numerous benefits to providers, payers and patients alike. Eligibility and formulary & benefit (F&B) transactions have long informed prescribers about a patient's prescription insurance plan coverage and which medications are covered under the patient's formulary. 

Continuous improvements from stakeholders involved in the eligibility and F&B transaction have led to advancements in matching patients with their coverage and pharmacy benefit information at the point of care. These advances are critical to improving medication adherence and, in turn, better patient outcomes and improved patient, provider and Pharmacy Benefit Manager (PBM) and health plan satisfaction in the ePrescribing process. 

Eligibility data is foundational to the presentation of F&B information. It is also the building block for several newer, downstream ePrescribing-related transactions such as Real-Time Benefit Check (RTBC), electronic prior authorization (ePA) and specialty enrollment. When supported by complete and accurate eligibility data, these new transactions can help patients get on therapy more quickly by avoiding unwelcome surprises at the pharmacy and help providers and pharmacy staff avoid manual work and rework.

Key Takeaways

  • Payers & Pharmacy Benefit Managers have a key role in improving key data files that inform and improve the value of downstream transactions
  • EHRs have an opportunity to revisit how benefits data is displayed to be more valuable for providers  
  • Providers who have been dubious about the accuracy and usefulness of eligibility information and formulary and benefit data through their EHR should give it another chance.