In the quest to lower patient out-of-pocket costs, some pharmaceutical manufacturers have sponsored targeted copay savings messages to pharmacies during the e-prescribing process. This approach seems like a reasonable alternative to physical copay cards.  One reason is that the physical cards are not always used.  Another reason is that when the card is presented to the pharmacy, it is typically done so after the pharmacy has processed the electronic prescription and adjudicated the claim with commercial insurers.  This situation requires pharmacy staff to rework the prescription to add the copay savings information, which increases the wait time for patients. Therefore, messaging copay savings via the e-prescribing process would be a time saver in the pharmacy workflow process.

EMR system vendors are providing the copay savings information in the “notes” field of the electronic prescription, which was never the intended purpose of this free text area.  The notes field intended use is for the prescriber to communicate information to the pharmacy about the patient and the prescribed medication.  National Council for Prescription Drug Programs (NCPDP) created the Coordination of Benefit (COB) segment in the SCRIPT e-prescribing Standard for communications of benefits coverage information that, when the proper information is entered correctly (BIN, PCN, and Cardholder ID), can be used to communicate to the pharmacy the information necessary to process copay savings programs. EMR providers have not widely supported these fields.  One problem is that the COB segment does not include a method to share with the pharmacy information regarding the details (i.e.: financial benefit to patient) for a manufacturer’s savings program. As a result, EMR providers are utilizing the notes field with copay savings offers from brand manufacturers and discount card providers when brand and generic pharmaceuticals are not sponsored by a brand pharmaceutical manufacturer. Therefore, many electronic prescriptions include some type of discount or copay savings offer depending on the EMR provider.

In August 2017, PHSI used our website “Question of the Month”  to ask: “What percentage of the time do pharmacists and techs react to saving offers when seen with e-prescriptions in the notes field?” Survey results are as follows:

These results confirm anecdotal insights PHSI has received from both pharmacy and pharmaceutical manufacturer clients. The frequency of these offers are creating “alert fatigue” for pharmacy staff overlooking or ignoring information in the notes field, which results in poor uptake for sponsored brand copay savings offers.  For now, EMR system providers are receiving a revenue stream for these virtual messages and recognize proper utilization of the COB fields in NCPDP SCRIPT standard is going to require programming and resources to update. Once the programming changes are made, extensive training will be required for the prescriber and pharmacy to manage this process correctly. PHSI believes there is an opportunity to improve the process for EMR systems to communicate relevant information to pharmacies.

Published September 2017