To keep patients and members safe without sacrificing efficiency or profit, healthcare businesses need consistent drug data to help align decision-making and communication between players including pharmacy benefit managers, payers, physicians, and pharmacies.
Aligning drug data is crucial for effective decision-making
Drug decisions are not made in a linear fashion. Rather the various players involved in the lifecycle of a prescription engage in frequent back-and-forth:
- Pharmacy benefit managers (PBMs) / payers and physician offices/ electronic medical records (EMRs) communicate back-and-forth regarding what’s on patient’s drug formulary.
- Physician offices/EMRs and retail pharmacies send each other requests for electronic prescriptions and refill orders.
- Retail pharmacies and PBMs/payers are in constant contact regarding drug claim submissions and co-pay amounts.
This frequent exchange of data presents many opportunities for miscommunications and incomplete or inconsistent transfers of information. When these partners can align their drug decision workflow with a consistent drug data solution, it can help streamline processes and unify decision-making and communication across the continuum of care.
Drug data efficiency at the business level for prescribers, PBMs, and payers
Aligned data allows prescribers to choose the most cost-effective and time-effective scenario for their patients from the start by selecting only those drug therapies that are approved and on the payer’s formulary.
Payers perform analytics on drug products and drug pricing in part as a form of checks and balances on their PBM partners. When both PBM and payer are using aligned data associated with National Drug Code (NDC) identifiers that understand each other and can communicate information with interoperability to common pricing points, communications and business processes are more likely to proceed smoothly.
