New Software to Enable Patients and Providers to Collaborate on Medication Selection based on Patient’s Current Insurance Benefit and Potential Out-of-Pocket Costs. Debut Marks First National Deployment of Real-Time Benefit Check Capabilities
October 22, 2015
Rockville, MD – DrFirst, a leading provider of e-medication management software and services, today announced the launch of its new myBenefitCheckSM service, which provides real-time, patient-specific information to providers regarding a patient’s prescription drug benefit coverage as well as the out-of-pocket costs the patient will incur at pharmacy for prescribed medications. This feature will be available to users of more than 300 electronic health record (EHR) platforms that integrate DrFirst’s e-prescribing platform, as well as to users of DrFirst’s stand-alone Rcopia® e-prescribing platform.
The cost of prescribed medications is a leading cause of patient non-adherence to drug therapy. Patient non-adherence – which contributes to an estimated $300 billion in annual U.S. healthcare costs – can increase the likelihood of disease progression, lead to avoidable doctor visits and increased hospitalizations, and otherwise contribute to poor health outcomes.
For providers, current information regarding a patient’s insurance coverage, coverage restrictions, therapeutic class guidelines, deductibles and other information that impacts medication selection and patient adherence is generally not known at the time of prescribing. Insurance benefit formularies change frequently and are increasingly complex, and it has been a challenge for payers to provide this information to doctors at the point of encounter with their patients.
“‘Is this covered by my plan?’ is a common refrain heard in virtually every physician practice,” said Richard Cohan, general manager of Patient Innovations for DrFirst. “The lack of cost and coverage transparency remains a major industry problem in terms of getting the right drug, at an affordable cost, to the patient.”
Based on the formulary and eligibility guidelines of a patient’s insurance coverage, myBenefitCheck analyzes the medication selections made by the provider during the e-prescribing process. Next, myBenefitCheck presents to the provider real-time information regarding whether a prescribed medication is covered under the patient’s formulary benefit design, offers up to three alternative drug therapies for consideration, provides guidance on alternative pharmacy options, including mail order and retail, and clearly presents the expected patient out-of-pocket costs for each option.
The National Council for Prescription Drug Programs (NCPDP) has worked over the past several years with insurance payers, pharmacy benefit managers, and pharmacies as well as healthcare IT vendors such as DrFirst to establish industry standards for benefit checking technology at the point of provider-patient encounter. Several pilot programs have been launched since 2014, however the roll-out of myBenefitCheck will mark the first full-production national deployment of such capabilities. DrFirst’s roll-out is being conducted in partnership with Humana, which will enable secure access to requisite coverage and cost data for its member base.
“We believe myBenefitCheck will be seen as a great leap forward in getting critical coverage information to providers and improving patient adherence to their medications,” said G. Cameron Deemer, president of DrFirst. “Our goal is to create transparency around drug selection decisions so that all stakeholders – physicians, pharmacists, health plans and patients – will be empowered to make the best therapeutic decisions based on the patient’s medical need, insurance coverage and medication costs. Our process also eliminates many of the administrative obstacles that can too often delay a patient’s start or continuation of drug therapy.”
myBenefitCheck will be available to users of DrFirst’s stand-alone Rcopia e-prescribing platform beginning October 26, 2015. The service will be made available to all users of DrFirst’s EHR partners beginning November 1, 2015.
DrFirst (www.drfirst.com) pioneers technology solutions that inform the doctor-patient point of encounter, optimizing provider access to patient information, enhancing the doctor’s clinical view of the patient, and improving care delivery and clinical outcomes. Our growth is driven by a commitment to innovation, security and reliability across a wide array of services, including medication management and secure communications. We are proud of our track record of service to over 340 EMR/EHR/HIS partners and an extensive network of providers, pharmacies hospitals and post-acute care facilities.