Dean Riggott Photography
Surescripts
Too often, a complex journey lies between patients and their prescriptions. Out-of-pocket costs pose a barrier. Payers struggle to reach care teams with important benefit coverage information. And a prior authorization process that depends on faxes and forms consumes valuable time and attention for everyone.
If the prescription is for a specialty medication—with high costs and complex requirements around documentation and dispensing—complexity increases. When prescribers and specialty pharmacies must contend with missing data, outdated technologies and manual processes, costs rise while patients are kept waiting.
All of this changes when clinicians at multiple points in the prescription journey can efficiently access benefit and authorization information. In 2023, the Network Alliance worked together to help patients get affordable medications sooner—promoting adherence while helping clinicians win back time for patient care.
Eligibility
Eligibility gives clinicians real-time access to plan-level prescription benefit coverage information—the first step in identifying an affordable medication option.
In 2023, many Eligibility users and their patients benefited from the primary coverage indicator. This feature helps identify the right plan to use for patients who are covered by multiple prescription plans—a group that includes about 13% of the U.S. population.
4.54 billion care events informed by Eligibility
642.2 million Eligibility transactions with multiple coverages processed
63% of Eligibility transactions informed by primary coverage indicator
12% reduction in erroneous selection of secondary Medicaid
On-Demand Formulary
On-Demand Formulary brings plan-level drug formulary information into prescriber workflows from pharmacy benefit managers and health plans in real time. For EHR vendors, this replaces the traditional process of downloading large formulary files each week and helps them give prescribers the most current medication coverage information. The number of healthcare professionals using On-Demand Formulary nearly doubled in 2023.
E-Prescribing
E-Prescribing lets clinicians securely prescribe medications within their electronic workflows—opening the door to better prescriber/pharmacist collaboration and clearer, more complete data that helps reduce safety risks.
At the end of 2023, 1.29 million prescribers were using E-Prescribing (a 4.9% increase from 2022), and 83.2% of them were also enabled for Electronic Prescribing for Controlled Substances (EPCS). Virtually all pharmacies were enabled for both E-Prescribing and EPCS. Among the 2.5 billion e-prescriptions processed, 21.0 million were for specialty medications (a 5.0% increase from 2022).
Keeping care teams aligned with CancelRx & RxChange
E-Prescribing transactions like CancelRx and RxChange are a powerful way for pharmacists and prescribers to connect quickly on medication updates, without faxing or phone calls. When a prescriber discontinues a medication, CancelRx helps ensure it isn’t filled at the pharmacy. RxChange makes it simple for pharmacists to alert prescribers when instructions are unclear, prior authorization is required, the medication is out of stock or lower-cost alternatives are available.
Streamlining prescription renewals with Sig IQ
Originally developed to enhance medication histories, our Sig IQ technology translates free-text patient directions into a quality-controlled, clinically validated format in order to protect prescriber intent and patient safety. In October 2023, we expanded the use of Sig IQ to add a Structured & Codified Sig to RxRenewal Requests sent by pharmacies—which means prescribers can approve the request in fewer keystrokes.
1.4 million RxRenewal Request transactions augmented by Sig IQ in Q4 2023
Specialty Medications Gateway
Specialty Medications Gateway allows specialty pharmacies to retrieve clinical data directly from the prescriber’s electronic health record, helping them streamline enrollment, expedite fulfillment and manage therapy.
107.2% increase in Specialty Medications Gateway transactions
259,699 prescribers automatically supplying patient information to specialty pharmacies
Specialty pharmacists access more information with fewer phone calls
Walgreens implemented Specialty Medications Gateway in June 2022, and as of July 2023, 85% of their specialty pharmacy locations had integrated it into their daily workflow. Today, their pharmacists are using Specialty Medications Gateway to access thousands of clinical documents electronically.
- 63% of users reporting fewer phone calls to prescribers
- 98% patient match rate
“This platform makes it easier for providers and pharmacists to focus on high-value services that our patients need.”
Jaime Bond, Pharm.D.
Registered Store Manager, Community-Based Specialty, WalgreensElectronic Prior Authorization
Electronic Prior Authorization lets care teams proactively initiate prior authorization requests and receive quick responses within their workflows, avoiding delays that can create frustration and stall treatment.
49% increase in prior authorizations processed electronically
20% increase in prior authorizations for specialty medications processed electronically
Real-Time Prescription Benefit
Real-Time Prescription Benefit brings clinicians patient-specific pricing and coverage details directly from the benefit plan, including information on prior authorization requirements, days’ supply options and therapeutic alternatives that may cost less. In 2023, 60% of all e-prescribers on the Surescripts network used Real-Time Prescription Benefit.
$37 average savings per prescription when used to find a less costly alternative
$785 average savings per specialty prescription when used to find a less costly alternative1
Instant cost & coverage insights save time for patients & pharmacy staff
Staywell Pharmacy owner Sanjay Sheshadri adopted Real-Time Prescription Benefit to help his staff find alternatives for non-covered medications, along with accurate information on copays and prior authorization. Now that these insights from Surescripts are integrated with their pharmacy management system, PrimeRx, Staywell staff can address cost and coverage barriers right away.
Average time needed to identify lower-cost alternatives
- Before Real-Time Prescription Benefit:
10–15 minutes
With Real-Time Prescription Benefit:
A few seconds
Average wait time saved by avoiding prior authorization
- 3–4 days
“The Real-Time Benefit solution allows us to deliver options and solutions that address the unique needs of each patient.”
Sanjay Sheshadri
Owner, Staywell Pharmacy
Footnotes
- Analysis includes prescriptions identified as specialty medications by Surescripts.
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