By Brian Bamberger, Life Sciences Practice Lead
The world of health care is rapidly changing due, in part, to the expanded use of electronic health record systems (EHRs) and integrated electronic prescribing (ePrescribing). Providers and payers – both key customers for managed markets (MM) groups in pharmaceutical companies – are finding ways to leverage technology for their advantage in improving quality and lowering costs. Providers increasingly are using EHRs to ‘write’ ePrescriptions. In fact, more than two-thirds of all office-based physicians were ePrescribing in 2012, and analysts expect nearly all to be sending prescriptions electronically very soon. Payers increasingly are using ePrescribing to influence drug and brand utilization, which then directly affects the success of pharmaceutical and biotechnology products.
As a result, MM teams should look to ePrescribing as an important tool to reach beyond their sales contacts and provide physicians and payers with brand messaging to achieve return on investment (ROI). A major opportunity involves achieving the best formulary for ePrescribers with the fewest restrictions. Studies have shown that much of the value proposition for ePrescribing to providers and payers lies in providing formulary and benefit (F&B) information at the point of care. There is a direct connection to ROI for MM teams because formularies exert a powerful influence on prescribing decisions and medication utilization.
Managed markets groups establish formulary position through contracts with payers. How EHRs display formulary is determined by the data provided by the payer and pharmacy benefit manager. To enhance the value of formularies, several things must be done. First is improving the quality of the data. Poor-quality formulary data are useless to physicians, who often ignore this ePrescribing functionality because of perceived gaps or errors. Next, physicians will need to review prior authorizations in their formulary data to implement the newly approved electronic prior authorization (ePA) standard. ()
Finally, formulary representation must be improved. Many people blame the sophistication of EHR applications in showing formulary data – or not showing formulary data, as the case may be. However, current research by Point-of-Care Partners (POCP) shows that the issue is more often related to the source data, which are missing the depth that the National Council for Prescription Drug Programs (NCPDP) formulary and benefit standard can include.
As a result, there will be increasing pressure to bring all formulary data up to the capabilities of the NCPDP F&B standard. These capabilities include:
As nationally recognized experts in ePrescribing, ePA, health information exchange and the NCPDP F&B standard, POCP can help pharmaceutical and biotechnology clients understand the payer and health information technology landscapes. We can put these in perspective and help clients with strategic positioning to maximize market impact now and in the future. Let us put our knowledge and experience to use in the management of these and other transformational shifts in health care.