Benefit and Formulary Information

An e-prescribing system that provides instant access to formulary and benefit information – such as informing a doctor that a particular drug isn’t covered or that a generic or off-patent drug will carry a lower co-pay – enables physicians to address coverage issues with the patient up front, says Boston health care attorney David Szabo, a partner at Nutter, McClennen & Fish LLP.

A doctor "can avoid the whole paper chase where a patient gets a prescription, goes to the pharmacy, is told it’s $50 a pill, gets upset, and calls you, forcing you to call the health plan or change the prescription," he says. "Some systems may actually be able to provide a doctor with backup clinical information about alternative medications or a mechanism for the doctor to appeal for coverage of a higher-cost drug."

Eric Poon, an internist at Brigham and Women’s Hospital in Boston, agreed. "Having formulary support is often very helpful," says Poon, who is also the hospital’s director of clinical informatics.

However, he wonders if there’s enough technological integration at this point to make these systems work.

"It’s not clear how this will be implemented across all different Medicare Part D plans to make sure there’s good mapping between the e-prescribing system the physician will be using and what’s actually on the formulary," Poon said. "The system needs to be able to recognize what the insurance company will pay for."

Next: Medication History