Friday, March 06, 2020

Insights into Prescription Decision Support Through the Patient Journey

Today’s guest post comes from Miranda Gill, Senior Director of Provider Network at CoverMyMeds.

Miranda discusses some of the findings in CoverMyMeds’ most recent industry report on medication access.

To learn more about prescription support and access, read the complete CoverMyMeds' Medication Access Report.

Read on for Miranda’s insights.

Insights into Prescription Decision Support Through the Patient Journey
By Miranda Gill MSN, RN, NEA-BC, Senior Director of Provider Network, CoverMyMeds

In the process of developing our annual industry report on medication access, CoverMyMeds gathered information from nearly 2,000 consumers on their experience obtaining prescriptions for themselves or those they care for.

Some data points were impactful, but not necessarily surprising. Those surveyed indicated that paying the lowest price was the most important factor when managing their prescription medications. It’s no secret that prescription price drives patient behavior. Even when out-of-pocket costs are as low as $10-$25, many consider not picking up their medications. In a 2018 study of 1,000 patients nearly 50 percent avoided filling a prescription because it cost too much when they arrived at the pharmacy.

Other results were more striking: our 2019 survey of more than 400 nurses indicated almost all were delivering patient medication information to the prescriber, and based on that information, nearly 75 percent influenced medication decisions at least weekly. But medication information isn’t easy to find. The majority of nurses are searching in multiple places for medication and benefit information, because the data they need isn’t located in one source.

What about the providers? They are aware of patient’s priorities, in fact 76 percent of providers surveyed said cost influences their decision-making when prescribing medications. However, the same percent said they rarely or never have reliable out-of-pocket pricing information available at the point of prescribing.

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From diagnosis to pharmacy dispense, patients need support at each step of the medication access journey. This means the entire care team needs tools and solutions that both enhance their knowledge and reduce barriers so they can focus on patients at the individual level.


Inclusive of real-time benefit check, prescription decision support encompasses off-benefit information as well as benefit details. Prescribers and staff can help patients select their best option for prescription payment and preference for pickup. Patients may choose to go through benefit or forego it in favor of a cash option. An optimal workflow allows providers to have a conversation about the best prescription options depending on the patient’s deductible status, out-of-pocket cost and patient preferences.


A full spectrum workflow considers office and support staff during and after prescribing. We know nurses are often responsible for searching for drug and benefit information, including history of tried and failed drugs, prescription benefit details, dosing, financial assistance resources and copay. Nearly three in four nurses reported they can’t find this information in one place. The results speak for themselves: Nurses and administrative staff stand to benefit from solutions that aggregate patient and prescription data in one place. Even with solutions in place, health systems and practices get bogged down with prior authorization (PA) request volume. A nurse in the survey described feeling like a ward clerk, as her time is taken up with the administrative management of medication access tasks.

Many health systems and practices are now redistributing and rethinking their employee structure, centralizing the PA process to an individual or team of experts to handle medication access barriers. These centralized teams are focused on more than just PA — they’re handling benefits verification, processing claims through their health systems’ pharmacies and ensuring financial assistance and other foundational programs are in place so that patients can get on therapy sooner.

A study by a leading medical center found that health systems with centralized groups processed PA requests nearly 6.5 days faster, on average, than non-centralized groups, and reported a 25 percent higher approval rate. This indicates patients could receive providers’ first-choice prescription and have it dispensed faster – improving the likelihood of adherence.

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Many electronic prior authorization requests are completed retrospectively by the patient’s pharmacy upon a PA-related claim rejection. The most effective prescription decision support tools today identify PA requirements and allow for electronic initiation at the point-of-prescribing. This facilitates easier prescription claim processing at the pharmacy, saving patients valuable time and setting the stage for more productive conversations at the pharmacy.


With high-deductible plans rising in frequency— and 75 percent of patients never seeing the other side of their deductible — it makes sense why patients are trying to cut medication costs where they can. Consumer prescription decision support tools enable patients to price-compare across local pharmacies and receive medication in a way that’s most convenient to them – sometimes right to their door.

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True end-to-end support includes the pharmacy and pharmacist. In a 2018 survey, pharmacists stated they’re only able to spend 10 percent of their time engaging with patients around how to safely and effectively take medication, potential side effects and compliance. Instead, it’s often spent on the phone with doctor’s offices, handling insurance-related tasks and data reporting. While prescription decision support tools have an increasing presence at the point-of-care, available tools dwindle when it comes to the pharmacy. Nearly half of providers surveyed said they still view the pharmacist as responsible for finding the price of a prescription. This view can project the perception of the pharmacist as a cashier rather than a member of the patient care team. PA resolution tools and benefit transparency technology in the pharmacy can clear final barriers between a patient and the medications they need to live healthy lives.

For a more in-depth look at prescription decision support as well as a wider medication access view, read our Medication Access Report and accompanying sub-reports.

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