By Martin Burruano
Payers are increasingly adopting real-time benefit check (RTBC) technologies to improve pricing and dosage transparency for providers and patients. In this interview, Martin Burruano shares why Independent Health partnered with DrFirst to integrate RTBC into providers’ workflows, as well as what payers should keep in mind when adopting similar tools.
What inspired the partnership between Independent Health and DrFirst?
There was an obvious unmet need for transparency and information in our provider community. This was regarding plan-specific drug formulary coverage information, as well as transparency related to overall drug costs and patient costs when providers prescribe a medication.
A patient’s copay, coinsurance, whether they are in a high deductible health plan—all that information is beneficial for providers to have at the point of prescribing.
Can you tell us about how myBenefitCheck works?
myBenefitCheck through DrFirst is directly integrated into the electronic medical record (EMR) and eprescribing platform. DrFirst had a large net of coverage for our prescriber communities’ EMR platforms, which was important in our decision to engage with this vendor.
When a provider prescribes a drug to a patient, information is readily available to them, such as whether the drug has prior authorization requirements, whether there is a quantity limit, or whether there is a step therapy requirement. Then they can see the member’s liability in real time and have that conversation with the patient at the point of prescribing.
Another advantage is that myBenefitCheck provides lower-cost drug alternatives for the prescriber to see. If there are issues regarding a drug’s affordability and overall cost effectiveness, a provider can have that conversation with the patient.
What specific challenges do you seek to address by adopting this RTBC?
Most of our primary care providers are on value-based reimbursement models. It is important for the provider to know what the most cost-effective medications are at the point of prescribing because the goal is to deliver lower-cost quality care, which includes lower member and patient costs as well. In the end, it is a win-win situation.
As payers continue to adopt RTBC technologies, what should they keep top of mind?
For us, the ease of use for the provider was important because this does not work unless providers adopt and use this tool. Direct integration into their electronic medical records and eprescribing platforms is critical. We did not want to create any undue burden on the provider.
This tool could be implemented directly into their workflow through a single sign-on method, which means they do not have to go outside their EMR log-in to an additional application to get information. When the provider prescribes a medication and enters that medication into their system, the benefits are readily available and user friendly.
Ease of use, direct integration, and implementation into a provider’s existing workflow are the 3 critical components to keep in mind. Also, with whatever platform you use, ensure you are covering the vast majority of EMRs within your provider network.
About Mr Burruano
Martin Burruano is the vice president of pharmacy services at Independent Health. Independent Health is a nonprofit health plan serving the 8 counties of Western New York. Independent Health provides commercial employer group benefits, as well as government programs such as Medicare and Medicaid. Independent Health also owns and operates its own PBM and specialty pharmacy, called Pharmacy Benefit Dimensions and Reliance Rx. Mr Burruano has been overseeing the pharmacy benefit for over 20 years.
Published by First Report Managed Care – August 15, 2022