How should pharmacy benefit managers (PBMs) and pharmacies communicate with physicians?

by George Van Antwerp

In the pharmacy and pharmacy benefit manager (PBM) business, there are lots of reasons to reach out to a physician:

* Drug-drug interactions
* A chemically equivalent version of the drug prescribed is available
* A therapeutically equivalent version of the drug prescribed is available
* The prescribed drug is not covered
* A prior authorization is required
* The patient is required to try an alternative drug first (step therapy)
* The prescribed drug costs too much and the patient would like a new drug
* The prescribed drug had unplanned side effects
* The patient’s prescription has to be renewed
* The patient is required to move to mail

The question is always how to best do this.

Here are some options:

1. Call the physician’s office.
a) Using call center agents would be expensive, and after navigating an interactive voice response (IVR) tree and talking to the front office staff, they would simply leave a message. This would just lead to an ineffective back-and-forth in many cases.
b) Automated technology won’t effectively navigate the IVR tree, sit on hold, and deliver a message.

2. Send a letter to the physician.
a) This allows for the proper level of information to be provided so the physician has time to look up the patient record and respond.
b) For most of the cases above, the time lag on this would be unacceptable.

3. Fax the physician.
a) This is the default solution since you can deliver mail type content in a timely fashion.
b) But, there is no great physician fax database.
c) And, do physician’s read the faxes?

4. E-mail the physician.
a) This isn’t really an option since there’s no physician e-mail database (that I know of) and you can’t send PHI via e-mail.
b) Your only option here would be to send e-mails that alerted the physician to log into a portal where all these messages were waiting for them.

5. Use the EMR or eRx application.
a) As physician’s get more automated and technology becomes the default workflow solution, everyone sees this as the holy grail. A pop-up can tell the physician about inbound messages for them to respond to.
b) Some solutions hope to push this messaging to the time the prescription is written which I think is fascinating, but I don’t imagine a physician wants to deal with all that during the patient encounter. (Maybe I’m wrong.)

So, what I’m interested in hearing from physicians on is what works. I’m sure you want to say that most of these messages aren’t things you want to deal with, but plan design is here to stay and works to control costs. I’m sure some of you feel this is the “managed care system” telling you how to prescribe, but we know that the amount of information needed to keep current on everything is overwhelming. And, cost matters to patients which means getting them on the right drug that they can afford will impact adherence and ultimately outcomes.

How should PBMs and pharmacies communicate with physicians?

George Van Antwerp is the general manager of the pharmacy practice at Silverlink Communications who blogs at Enabling Healthy Decisions.

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