Impact of Real-Time Pharmacy Benefit Information at Point of Discharge on a Provider-Sponsored Health Plan
Purpose: Prescription medications account for nearly 10% of national healthcare expenditures ($3.4 trillion in 2016). Appropriate medication prescribing may reduce costly complications, impacting overall healthcare costs. Limited knowledge of the cost of medications coupled with the dynamic nature of prescription insurance formularies makes it difficult to ensure prescribing of cost-effective drug therapy. The objective of this study is to evaluate the impact of pharmacy benefit information availability using real-time adjudication at the point of discharge on patients’ ability to acquire and remain adherent to medications as well as the economic impact to a provider-sponsored health plan. Methods: Memorial Hermann (MH) has implemented a transmission system that provides real-time pharmacy benefit information (RTPBI) for patients at the point of prescribing within the electronic health record (EHR). A multicenter, retrospective cohort study of all covered lives under the provider-sponsored health plan treated in a MH inpatient facility from July 1, 2016 through June 30, 2017 was performed. Patients with real-time prescription benefits available through the transmission system were compared to those without to determine percentage of preferred versus non-preferred/non-formulary medications prescribed as well as the time to first/second prescription fill. Criteria for appropriate versus delayed procurement were defined. Results: The study included a total of 2,340 patients (696 patients RTPBI functionality available and 1,644 that did not at the point of prescribing at discharge). The primary analysis showed a large difference in the prescribing of preferred medications between patients who had RTPBI available at the point of care and those that did not. RTPBI significantly reduced the amount of non-preferred/non-formulary medication prescribed at the point of discharge (6.9% non-preferred/non-formulary prescribed when RTPBI was available; p < 0.001, 95% CI 0.056 – 0.111). Secondary analysis of time to first prescription fill did not show a statistical difference. However, analysis of time to second fill showed that RTPBI availability significantly impacted patients’ ability to acquire subsequent fills appropriately (69.0% versus 49.6%; p < 0.001, 95% CI 2.026 – 3.198). Conclusion: The availability of RTPBI at the point of discharge significantly reduces the prescribing of non-formulary medications. Based on the results of this study, it has the potential to improve prescribing of preferred medications. Future studies should evaluate the implications RTPBI would have on economic impact, medication adherence, and readmission rates.
Real-time, Pharmacy benefit, Provider-sponsored, Health plan, Adjudication
Networked Digital Library of Theses and Dissertations