Improving the Efficiency of the Prescription Process and Promoting Plan Adherence

Stephen E. Wogen, MHA, George Fulop, MD, MS, Judith Heller, RN

In This Article

Abstract and Introduction

Growing prescription volumes and complex pharmacy benefit designs have contributed to inefficiencies in delivery of the pharmacy benefit. Point-of-care (POC) prescribing systems are hypothesized to reduce these inefficiencies while improving formulary adherence through electronic communication of patient benefit information to prescribers before the prescription is written. We tested this hypothesis at a 14-physician medical practice. Implementation of an electronic prescribing system incorporating formulary messaging led to a 42% reduction in number of pharmacy calls to the physicians' office. Formulary-related calls decreased 84% while compliance with the plan formulary was maintained, and prescription clarification calls (eg, because of illegibility) fell 30%. Mail-service pharmacy utilization increased at twice the rate of that in a control group, helped by the inclusion of passive remind ers of a home delivery benefit transmitted electronically at the point of care. POC technology facilitates management of the pharmacy benefit by providing prescriber access to patient-specific clinical and benefit information during the patient encounter. Efficiency gains for patients, physicians, and pharmacists can be realized while also improving benefit plan adherence.

Pharmacy benefit management is a complicated process, especially in view of the need to comply with often competing objectives. Plan administrators expect their PBM to reduce drug trend and spend, while also ensuring the delivery of affordable, high-quality pharmaceutical care to their members or employees. The current prescription process results in handoffs and a high percentage of non dispensable prescriptions requiring rework (Figure 1). Electronic prescribing has the potential to streamline this process and eliminate inefficient processes.

The current prescription process results in handoffs and a high percentage of nondispensable prescriptions requiring rework.

Electronic prescribing is rapidly evolving into a viable tool for assisting plan administrators, PBMs, and health insurers in attaining their common goal of promoting safe use of medications while meeting financial objectives.[1] Electronic prescribing can simplify pharmacy benefit plan management by focusing on the physician's office at the time prescribing decisions are being made. It is at this point when the member and prescriber are making key decisions regarding allocating pharmacy benefit resources, rather than after the patient has left the physician's office with a prescription.

Electronic prescribing can eliminate members' inconvenience because of delay or even denial of a prescription at the pharmacy while helping to ensure patient safety through the elimination of handwritten prescriptions. Potential drug interactions can be reviewed by the prescriber before the prescription is written. Electronic prescribing also reduces other inefficiencies in the prescription process by improving compliance with generic and brand formularies and eliminating the need for follow-up phone calls to the physician that ultimately decrease member satisfaction and increase the cost of the benefit.

The Institute for Safe Medical Practice (ISMP) has called for the adoption of electronic prescribing tools and for the elimination of handwritten prescriptions in order to reduce the number of medication errors.[2] According to the ISMP, while medication errors can be introduced at several points in the medication management system (ie, naming, labeling, packaging, distribution, and fulfillment), errors can also occur when prescriptions are written; these errors are generally made by the physician.[2] The Academy of Managed Care Pharmacy, in an updated version of its position statement on electronic communication of prescription information, also cites the reduction of errors due to illegible handwriting as a benefit of electronic prescribing.[3]

In this report, we describe the impact of introducing an automated electronic prescription process in a large primary care practice and the benefits realized by plan administrators, members, and physicians. We hypothesized that the use of electronic prescribing technology would reduce prescribing inefficiency while improving drug benefit adherence through proactive communication of the pharmacy benefit.