Kelly Wendlandt: Leading. Following. Inspiring. Living.

ePrescription, PBM, Pharmacy Benefit-Rob Mohr & Melissa Brown

August 19, 2022 Kelly Wendlandt Season 1 Episode 7
Kelly Wendlandt: Leading. Following. Inspiring. Living.
ePrescription, PBM, Pharmacy Benefit-Rob Mohr & Melissa Brown
Show Notes Transcript

In this weeks episode we talk to ePrescription experts Rob Mohr and Melissa Brown about the state of ePrescription, payors and how the industry is evolving.  For people in Pharmacy, Pharmacy Benefit Management and Insurance, it's a hot topic and one at the forefront of how technology can lower cost and improve outcomes in healthcare.

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Kelly99
And we are live with the Kelly Wendlandt Podcast- it is Friday... how are you doing Rob Moore Melissa Brown?  Always love it when it's Friday.


00:05.36
Rob
Doing great.

00:05.72
Melissa Brown
Um, great. How are you.

00:18.44
kelly99
I'm just jumping right? at you? No no small talk. No chit chat? Yeah um, when I think about ePrescription I think about being at my doctors and getting a good accurate prescription sent from the doctor's office...
So that I can go to my pharmacy at Target or Walmart or wherever and and have that same brand and prescription sitting there and me not have too much hassle with with the insurance process is that how you guys think of it and what what are What do you do with any prescription that make you know that allows that process to work.

00:57.78
Rob
 you you hit it on the head for what I enjoy about this type of area is that it's totally relatable to what everybody does in their daily life right? A lot of people get prescriptions. Um, we've been doing this for 20 years now and in in the beginning. There is so much resistance to. Um, by physicians to only use paper in that prescription process. Now. It's normal, right? Just like you said now you expect it as a consumer to have it pick the pharmacy sent and it's accurate when it shows up. So yeah, That's exactly what we think about it what we're implementing here What we do is all the middleware between. The emr the the system that the clinic and the physician use to get it from their system securely through a channel to get it all the way to the the pharmacy accurately and we could talk about all that side all the other additional benefits through the benefits on the medical and and. Pharmaceutical benefits stuff like that. But that is the that's the gist of it right? there.

01:55.16
kelly99
Okay, and how much technology is there in  the middle that as consumers we don't see what what is going on from the point that the physician says you need. You know, an antibiotic to the point I pick up the antibiotic who's who's in the middle there.

02:14.21
Rob
There's  different hubs in the middle. We're primary players right here in Minneapolis with with surescripts but the player in the middle what they're doing is they're  standardizing that approach... before they came along what would happen would be to get your Pharmaceutical benefit information to the clinic or to get access to the pharmacy. These PBM's would have to try to connect to all these places individually we needed. Ah you know the whole spoke model but where they could go into a black hole or some unknown place and that place would hopefully know how to route it properly but beyond that what a company like that does is it  standardizing the process for communication between all parties.  You've got clean drug names. You've got appropriate you know quantity unit of measures. You got the right medication for the right therapy things that are using the system and using a whole library of information instead of just relying on a piece of paper that a physician fills out.

03:04.94
kelly99
Ah, interesting. So when you say the right medication for the you know for whatever the the therapy might be are these systems working with the doctors or with The. Um, whatever the software is the doctor is using to make sure that what's being prescribed is is appropriate or or is a commonly prescribed kind of drug for whatever that malady is.

03:30.41
Rob
Yeah I'm i' hogging this conversation but this is mosts of specialty here because Melissa most was in charge of developing a great solution around that at at share script. So let's once you talk about you know,  EMR's, PBM's and formularies like that.


03:42.66
Melissa Brown
Yes, yes, So yeah, there's a number of things that take place prior to the prescription actually being written that help um, support that Workflow. So The prescriber has the opportunity through the implementation with you know, vendor or solutions like. Sure Scripts where they can identify you know does a patient have insurance. What? what different um drugs are on that patient formulary and over time. There's a new product or service that's available. It's called the real time Benefit. Um. Check solution and that allows the prescriber to make an informed decision with the patient sitting right? there in terms of what drugs are covered. What's the actual cost of the drug is there any prior authorization or any other steps that will need to occur before. Actually prescribing that medication so there are a number of different transactions that can be implemented into the prescriber's workflow to help inform that process.

04:51.97
kelly99
How much integration. How much technology is going into that whole process. It sounds like there's a lot of spread out entities and a lot of spread out Data. So is your is your world mostly figuring out where data is and making sure the data is clean and then. Connecting all of it is that is that what you how you would describe it or is it something else.

05:14.51
Rob
A lot of this information you know, existed within. We've been saying pbm. It's a pharmaceutical benefit management company right? It's ah in town here. You know you got prime therapeutics or you got express scripts or Cbs Health Formerly Care Mark those type of companies are ones that hold these this. This abundance of information about well not just what medications are going to be covered on a particular formulary but which one are therapeutically appropriate stuff like that that information resides in their systems right? and then we needed to have a solution that could get that information in front of physician like Melissa was saying. The point of prescribing rather than having it get down to the point where it's at the pharmacy and they have to change medications. So what? what we do? What lodgesoft does is we work in that middle to allow the information to get pulled from that pbm and security processed through the system to the clinic. To the point that it shows up right? at the point that the person puts the ah puts the drug name in in this way. What because what happens is too many times a if there is a problem with that drug when they get to the pharmacy. You know people will tend to walk away and not take that medication which. Results in moread readmits to the hospital. They're not're not compliant with their drug taking. Um, so that's the that's the real problem and if we can get the information when the physicians still there with the patient that improves the performance of that particular medication and to to answer your question though. It's. We're handling the the transfer of that information the processing of making sure it's in a standard format and integrating that within the emr's workflow.

06:49.24
kelly99
Um, and how how long has this been. You know the eprescription started you know fit what fifteen years ago or ten years ago is that right.

06:54.31
Melissa Brown
Um.

06:57.11
Rob
No more than that. Um, we we were lucky enough because we live in Minnesota we were lucky enough to be so on the ground for of of what's ax hu back in the day in 2001 and that's when the pbm was put together our ex hub which now is normal known as she scripts. Um. I saw that actually 3 of our members that are still with us. We got to be on the ground floor that of establishing that particular company. Um as consultants and then as it um and then I don't I can't remember Melissa if you remember the none none day in eligibility transaction actually went across was probably a couple years after that where that's the passing of coverage information to the emr which didn't exist before and then since then it's now they're passing you know none and None of transactions daily. So it's been gone for a while.

07:36.26
Melissa Brown
Um, yeah.

07:47.23
Melissa Brown
Yeah I yeah I'm often amazed by where we've seen this evolve from you know to your point Rob with the none day of being able to send an eligibility transaction. You know between our ex hub now sure scripts. Um, to you know our pbm partners and some of our partnering yeah e hr vendors. It was like huge and where we've seen this evolve over time to not only are you know is this just commonplace. But we're also seeing the use of you know, controlled substances which. When that was none introduced about ten years ago um there was legislation that was needed to allow eprescribing and now we're seeing that switch where states are actually now mandating the use of of um e-prescribing for controlled substances. Um, for certain medications. So. It's just interesting and I just that's the part. That's what I love about being in this space is just how much change we've seen over the last twenty years um that really just started you know on that none day with that eligibility transaction and all the other. Capabilities that have gone along with that. It's just been a really exciting place to be.

08:59.44
kelly99
Is that Melissa is that what's hot in the industry is legislation occurs and that forces um change in how in what's what's going to be required from from any prescription perspective from a tracking perspective.

09:07.41
Rob
Um.

09:17.52
kelly99
Is is that what's driving the industry right now is legislation or is it something else. So.

09:20.25
Melissa Brown
I Would say you know I think it was a big part initially to to help drive adoption. Um, certainly around deprescriing and then with controlled substances. Um, it's also been a big player I I think there's also you know legislation now trying to drive. Um, adoption for the use of electronic prior authorization as well and one set legislation is you know in place then it certainly does help drive adoption of those capabilities.

09:50.41
kelly99
What what is prior authorization.

09:53.66
Melissa Brown
So prior authorization is needed when um, pbms or the pharmacy benefit managers work together with their um customers to define whether or not really high costs. Usually specialty drugs require an approval from the health plan prior to the provider being able to prescribe that medication and um, it takes a long lot of manpower. Um, it takes time to get completed and oftentimes. When a prescription isn't going through the prescribing process. The the pharmacy could just end up getting a prescription and realize when they process the claim that prior authorization is required. And um, what happens with Epa solution is that that actually brings it upfront into the workflow and the provider along with the patient identify that a prior authorization is required and then at that point they can take action electronically. To work that prior authorization and get it approved electronically so what used to be take weeks or even in some cases several like a month or more um they can reduce that down to a matter of hours to getting that prior authorization approved. And taking care of all of that upfront prior to the prescription even arriving at the pharmacy which is a huge win. Um because it gets people onto their medications and usually these are for folks that are dealing with some pretty complex medical conditions in a lot of cases. So um. We can handle that prior authorization process upfront earlier in the workflow make it easier for the patient the prescriber and the pharmacy. It's it's just a win across the entire ecosystem.

11:48.30
kelly99
Sure Sure what's what's next any prescription is there ah is there a future state where you know everything is fully integrated and and there's no longer need for you know for the integrations and. Prior authorizations will will the systems get to that point or with legislation will there always be changes that are required in your mind.

12:13.55
Rob
I Think there's Opportunity. There's obviously more opportunity for additional transaction sets to be utilized right? Yeah, just because legislation came along and kind of pushed e-prescribing along that got a lot of people on board. But now there's transactions that it could be valuable that still need to be implemented that. Could tell like like for instance, 1 of them like a fill transaction. It tells the physician exactly when and if that medication got picked up by the patient at the pharmacy valuable information to no to see if they ah there um have good drug adherence for that particular patient or not.

12:34.37
Melissa Brown
You.

12:49.35
Rob
There's things like that that still there's still a lot of opportunity to advance there you hear a lot of things in the news about pricing transparency and that's some of the stuff that we're talking about here with the rtpb transaction that Melissa was talking about where getting. More knowledge in front of the patient about what they're paying and how how much they're paying how much their insurance is paying how much they won't pay what's their copay you know stuff like that. There's opportunity there. But as far as like getting rid of some with a red tape as far as like like like you mentioned prior off I don't I don't know if there's plans for that ever to be to be dismissed but there's opportunity if you with paying for medications outside of your benefit now with like ah different companies that do couponing and like the good rx type of solution where I might be able to get the medication cheaper someplace else and you're just given more information to the patient who needs to make the right decision to not only get the right medication but at a. At a ah price they can afford.

13:41.95
kelly99
Are these solutions being integrated into handheld applications that patients customers have on their phones and they're looking and saying okay you know I've got my prior oth I can go down to the to the pharmacy at this point or hey it looks like there's a. And option for me to coupon with a different company here is it is it to that point yet or is that a future state.

14:02.90
Rob
No there. There are some tools that are available like that um companies like share scripts have to be careful because they they only have certain data rights for that information so they can't do everything that you might dream up for providing information. Um, but there are there are services and tools out there that that they're trying to put that information into like you said in handheld any type of device that the patient can make a more informed decision. That's that's a state we're in right now right? is people want to have that information in their hands and make the decision because they're the ones that are being affected the most if the medication is. $5 cheaper here than there then why not put that information in their hand so they can get it right.

14:43.18
kelly99
Yeah, yeah, that makes a lot of sense. Um, we've run out of time. Really appreciate both of you taking time to be on the Kelly Winland Podcast Melissa Brown Rob Moore thank you everybody have a great Friday in great weekend.