Practice Fusion offers enhanced real-time prescription benefit (RTPB) checks in the e-prescribing (eRx) workflow for patients with a prescription plan managed by Express Scripts or CVS/caremark™. This feature allows eRx enabled users to view patient medication cost and cost-saving alternatives at the point of care via the patient’s pharmacy benefit manager (PBM). By providing real-time, patient-specific benefits information and cost-effective medication options, prescribers can make informed decisions that help reduce payment obstacles for patients and increase medication adherence.
Medication cost and cost-saving alternatives will only appear if the order meets the following criteria:
- Patient has an address listed in their profile
- Patient has insurance information recorded in their profile and a prescription plan managed by Express Scripts or CVS/caremark™
- Patient has a preferred pharmacy set in their profile or pharmacy has been selected in a previous e-prescription for the patient
- Quantity, unit of measure, and days supply are entered for the medication
- Only one medication is selected for the order
In order to view medication costs, cost-saving alternatives, and formulary information, you must be enabled for eRx. Nurses, medical assistants and other staff that may assist prescribers with entering medication order information will not be able to view this information due to restrictions from the e-prescribing network. For information on how to get started with eRx, view the following resources: enable e-prescribing, send an eRx, set preferred pharmacy, formulary frequently asked questions. Once you are enabled, you can get started by following the instructions below.
1. Order Medication Add a medication from the Summary tab of a patient’s chart, the medication table in an encounter, the Plan section of an encounter, or from a lab result. After choosing the medication, fill in the quantity in the corresponding fields: Dispense, Unit, and Days Supply (see Graphic 1 below). This information must be entered in this step of the workflow to view real-time patient cost and cost-saving alternatives based on the patient’s coverage. If nothing is entered for Days Supply, it will default to 30 days. Click Order to continue.
Graphic 1: Dispense, Unit, Days Supply
2. Confirm Medication Click Next to confirm your medication selection as shown in Graphic 2 below. If additional medications are added to the order in this step, medication cost and cost-saving alternatives information will not be available for this order. If multiple medications are added to a single order, the real-time benefit check will not occur and you will not be able to see medication cost or cost-saving alternative medications for the order.
Graphic 2: Medication Confirmation
3. Review available cost-saving alternative medications Review the estimated patient costs for the requested medication and any alternative medications as shown in Graphic 3 below.
- Patient cost for requested medication: Based on the patient’s coverage, the patient’s out-of-pocket cost information may be available for the requested medication based on the quantity, unit, days supply, and pharmacy selected for the order. Cost and any coverage alerts will be displayed at the top of the screen. Coverage alerts may indicate that the patient’s benefits do not cover the requested medication or if there are other coverage factors that the prescriber should be aware of before sending the prescription.
- Cost-saving alternatives: Based on the patient’s coverage, cost-saving alternative medications may be available for retail, mail-order, 90 day retail, and specialty pharmacies. Cost-saving alternative information includes estimated patient costs and any associated coverage alerts. Click Next to continue with the original medication or choose Replace to replace the original medication with a cost-saving alternative for the prescription order.
- Note: These alternatives may be less expensive and offer additional prescription benefits, allowing you to select the best option for your patient. The options for the alternative drugs presented have been selected by your patient's PBM and may not constitute an exhaustive list of alternative drugs made available using the traditional formulary workflow within the eRx workflow. Actual pricing may vary depending on plan structure, deductibles, previous payments, future claims and prior authorizations. Information provided may not include possible drug interactions or other safety alerts. As such, these options should not serve as a substitute to your independent medical judgement in providing the appropriate treatment to your patient.
- Formulary information can still be viewed by selecting the “Formulary” toggle.
Graphic 3: Cost-Saving Alternatives
Evaluate alternative pharmacy options: Some medications may qualify to be filled via mail order or for a 90-day supply benefit. Review these options to help increase patient adherence by selecting the most convenient pharmacy option and/or take advantage of ordering more to save your patient money. To view these additional options, select from the Retail dropdown menu as shown in Graphic 4.
Retail Review additional drug alternatives available at your patient’s pharmacy of choice.
Mail order Patient cost may differ between retail and mail order pharmacies for the same medication. If the original medication is available through a mail order pharmacy and you’d like to take advantage of this option, select Replace.
90-day retail 90-day benefits may be available for the original medication at the patient’s pharmacy.
Graphic 4: Retail, Mail Order, 90-Day Retail
4. Cost-saving Alternative Medication Applied When a cost-saving alternative medication has been selected as a replacement, the Dispense, Unit, and Days Supply fields will pre-populate on the order details screen based on the alternative that was selected. Modifying the dispense, unit, or days supply on the order details screen may affect the estimated patient cost (see Graphic 5 below). Fill out the remaining fields as necessary. Click Next to continue ordering medication.
Graphic 5: Changing Required Fields May Change Estimated Cost
5. Finalize the medication order Review the order summary. Cost coverage details for the selected medication will be listed on the summary for reference. Changing the pharmacy will affect the patient coverage information since prescription benefits are pharmacy-specific (see Graphic 6 below). If the pharmacy is changed, available cost-saving alternative information will change and need to be reviewed again via the link available on the summary. Click Send eRx to complete your order.
Graphic 6: Changing a patient’s pharmacy
If you keep the original medication:
In order summary, you can once again view the Cost-Saving alternatives by clicking the link as shown in Graphic 7 below.
Graphic 7: Order Summary
View the cost-saving alternatives from this window (see Graphic 8 below). Toggle between Retail, Mail order, and 90 day retail to see what will be most beneficial and convenient for your patient. Click Replace to choose one of the alternative medications. Click Keep original to choose the original medication, then click Send eRx to complete the order.
Graphic 8: Cost-Saving Alternatives from Order Summary View