Prescribing medication has become unfathomably complex these days, with rules interposed between the patient and physician by pharmacies, payers, and pharmacy benefit managers (PBMs). Drew Hunsinger, Executive VP, Corporate Strategy at DrFirst, points out that a single medication may have multiple indications (conditions for which it can be prescribed) and rules vary by indication. Colin Banas, MD, Chief Medical Officer, says that 90% of new medications are considered specialty medications with associated complex rules.
In our recent interview with Hunsinger and Banas below, we discuss how DrFirst relies on its 26 years of experience with medication management to help providers create clean prescriptions that arrive at the pharmacy ready to fill and help keep patients on their medications.
It’s no longer enough for doctors to make a clinical decision for their patients. For insurance to cover it, the provider must demonstrate to the payer or PBM that the patient has met the appropriate criteria for approval and construct the prescription details accordingly. Banas says, “Providers have been asked to play a game but haven’t been told the rules.” Plus, I would add that the rules keep changing. Hunsinger says that the payer may reject coverage because the doctor ordered a quantity beyond the covered maximum or prescribed it too soon after a similar order. These are just a few of the problems that DrFirst eliminates through automation.
To reduce the “ping-pong effect” of rejections and retries, Hunsinger says DrFirst can help EHRs get to 30-40% automation, avoid some prior authorizations altogether, and accelerate the rest through well designed technology.
A good deal of the interview also covers the importance of health IT proving that it’s trustworthy. DrFirst benefits from years of experience, and by being careful to provide useful information without overloading the doctor. They try not to disrupt workflows. Hunsinger says, “It takes one second to lose trust.”
Watch our interview with DrFirst to learn more about the evolving world of medication management and how good technology is improving the experience for clinicians.
Learn more about DrFirst: https://drfirst.com/
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