Let’s face it; parents are much busier today than a generation ago. Kids have more activities at a younger age. There are more medications today than a generation ago with varying degrees of managed care coverage. If there are three asthma medications in the same therapeutic category, prescribing the ‘on-formulary’ medication saves time for parents.
A Pediatric office accepts health insurance from multiple plans each with differences in formulary coverages. A ‘typical’ drug formulary is three tiers. Tier 1 is the generics tier, tier 2 is the preferred branded tier, and tier 3 is the non-preferred branded tier. Each plan has a range in cost to the patient. For example, tier 1 usually ranges $5-$10, tier 2 is $15-$35, tier 3 is $35 and up. Since the formulary status of medications at plans changes routinely, staying up to date would be a full time job for a busy Pediatric practice. This is where a well-built system that uses auto-formulary advice can save a practice time, lower costs to patients, and increase the adherence to a managed care plans formulary.
E-prescribing vendors and Electronic Health Record vendors have different options when they design and develop their systems. Surescripts/Rx Hub maintain the data on products on formulary for each plan. Many vendors link directly to the source (All Scripts, Nextgen, Physicianxpress) while others choose an indirect route via linking to another vendor (Dr. First). Either source is dependent on the Internet to check formulary and send the prescription (another reason to choose cloud-based system). When there is a problem with formulary advice: a vendor with a direct connection to sure scripts needs to only diagnose their own system and communicate with sure scripts while a vendor that connects to another vendor whom connects with Surescripts has three systems that there could be a problem.
Reliability Engineering confirms that more systems in a series lead to more chances of failure/error. Six sigma concepts also support less steps in the process. When selecting an EHR, ask if the vendor if their system has directs links and achieved certification directly from sure scripts for formulary advice and sending scripts/refill requests.
Over the next two years there will be some significant branded drugs that lose patent protection. This change in the market place will motivate managed care plans to further change and control formularies. Pediatric practices that routinely use the formulary advice feature of an ‘optimal’ system should reduce their administrative burden while reducing costs for patients and payers.