Improving Health Care With Physician Connectivity

Healthcare is hard enough. Physicians deserve a smarter pharmacy experience and so do their patients. Express Scripts has responded, investing more than $10 million in technology, people and partnerships to improve healthcare connectivity.

We provide essential information to physicians and other providers at the moment they need it. By eliminating faxing, phoning and wait times, and investing in healthcare connectivity, we alleviate administrative burden, reduce cost, and get medicine to patients more quickly.

As medical and pharmacy benefits become more complex, digital transformation is critical in avoiding disruption in physician offices. That’s why we’re so excited about our work with Surescripts, which provides patient care teams with a more holistic view of their patients and the best prescribing options for them.

What’s Covered? What’s Costly?

In addition to efficacy and clinical considerations, physicians must take cost and coverage decisions into account: Does the patient’s insurance cover this medicine? What is the copay? Is it subject to prescribing requirements, such as quantity level limits? Does the patient’s benefit plan require prior approval or trying another medicine first?

Together with our technology and Surescripts’ unique connection to hundreds of Electronic Health Records vendors (EHRs), we can now simplify the complexity for physicians within their workflow in their EHR.

With Real-Time Benefit Check, physicians can receive patient-specific information and pricing information from our system directly into their EHRs, within seconds of entering a medication name. Physicians using e-Prescribing can see the following components to inform their prescribing decisions:

• Alternative drugs and associated details, such as generic vs. brand pricing, pharmacy channel pricing differences and overall coverage by drug level limits
• Coverage information, including prior authorization, step therapy requirements and/or quantity
• The patient’s cost at each pharmacy dispensing channel: retail, home delivery or specialty pharmacy

We invested in our Real-Time Benefit Check technology with Surescripts because Express Scripts understands the challenges physicians face. We’re doing our part to help doctors practice more effectively and efficiently by building technology to more proactively address, right in the EHR, the myriad of coverage questions physicians and patients face.

In addition to eliminating administrative burden in the physicians’ offices, healthcare connectivity delivers benefits to patients and plan sponsors as well.

Patients receive the most appropriate, cost-effective medications with a smoother prior authorization process and less wait time. Plan sponsors see better formulary compliance, higher patient medication adherence, improved physician and patient satisfaction, and increased ability to administer more complex benefits.

Our Digital Transformation is Now

In addition to Real-Time Benefit Check, Express Scripts continues to invest heavily in other key capabilities to improve the physician prescribing experience:

• Clinical Direct Messaging takes previous fax and mail communications and puts them in the electronic channel to alert physicians to patient safety concerns, such as drug-drug interactions or over-utilization; adherence gaps for patients who are late to fill; or opportunities to move patients from more expensive, non-preferred products to preferred products.
• ePrescribing enhancements allow physicians to renew prescriptions, cancel prescriptions or answer pharmacy clarification questions.
• Electronic Prior Authorization (ePA) allows clinical questions to be answered right when the prescription is written. And, ePA can return approval decisions quickly – most times, within minutes.

Taken collectively, Express Scripts is building a suite of high-impact digital provider solutions to remove administrative burden and other barriers to physician care. We empower physicians to more easily do the right thing when it comes to making the best clinical and cost efficient prescribing decisions.