Fixing the Broken Parts
Healthcare Is Hard
In an August 23, 2021 article in Healthcare IT News entitled “Is Healthcare Too Hard For Big Tech Firms?” Paddy Padmanabhan wrote about some of the most powerful, well-resourced companies in America trying to enter the healthcare space…and failing. We are talking about Google, Apple, and Amazon…not some small underfunded startups. Healthcare is tricky, and it’s dynamic. Many layers and opposing forces with conflicting agendas must all be lined up and working in sync. This is why even these corporate giants have failed to solve the healthcare puzzle.
Maybe a complete overhaul is not the way to approach it. Perhaps it’s more effective to laser focus efforts on one single issue and master it, before expanding outward.
At EZSCRIPTRx, we knew going in, that we wanted to make a difference…an impact.
We all know that healthcare in America is broken. Whether we've experienced its downfalls personally, watched as friends or family dealt with navigating its inadequacies, or simply know the stats.
With so many holes that need to be plugged, most individuals and organizations feel powerless to change it. However, most change happens gradually. One small step can lead to many, which, if consistent, can eventually lead to systemic change.
So, after extensive analysis of the many "broken parts" within the US healthcare system, we decided to take on medication adherence, and the many pitfalls that exist within the prescribing process.
We felt that with today's advanced technologies and dedication to a singular laser-focused purpose, we could move the needle in this area.
It was a bold assertion, but we were determined.
Fast forward three years, and our software is now being used by independent Pharmacies to improve medication adherence across all 50 states and Puerto Rico. We are proudly watching that needle move before our eyes.
Why We Chose Medication Adherence:
The majority of Americans who have health insurance also have prescription drug coverage. Yet, large portions of the US population are not receiving the medications prescribed, due to coverage denials or unaffordable copays.
- 1 in 5 people with prescription drug coverage still struggles to pay for medication costs
- 3 in 10 adults had been denied coverage of a drug prescribed by their Provider, in the preceding year
- 18% of those in the top 1% of income earners did not fill a prescription because of a coverage denial
- 48% of middle-income and 51% of lower-income adults who were denied coverage, did not receive the medication prescribed to them
- Of those making over $500,000 a year, 18% said they did not fill a prescription after their insurance wouldn't cover it, even though they could afford to
- For those with income less than $35,000, that number was 51%
- For the $35,001 to $99,999 income group, 48% of them did not fill prescriptions after denials of coverage
With so many prescriptions not being filled, the adherence gap is widening even further. This creates a domino effect of painful, costly, and sometimes deadly results downstream.
We Decided to Address Medication Adherence By Empowering the Pharmacy and Provider to Become Patient Advocates
Most Patients are unaware of the existence of alternative medications and other therapies...or that there are medications with lower copays that may be covered under their benefits plan.
They assume their only option is exactly what was prescribed. It's either covered, or it isn't. Affordable, or out of their reach financially. End of story.
Even Providers lack this vital information about covered alternatives at the time of prescribing. It's a guessing game. They prescribe something and hope it's covered. Expecting the inevitable callbacks that tie up their staff, due to coverage denials or unaffordable Patient out-of-pocket costs. As they search for a solution, the Patient is left to anxiously wait for their medications, if they are lucky enough to get them at all.
Most everyone involved knows the system is broken. But what is the alternative?
We Built A Platform To Empower Pharmacies To Change These Statistics...One Script at a Time
Here's How: A prescription comes in, and the Pharmacy runs a quick intelligent Real-Time Benefits Verification (iRTBV) in EZSCRIPTRx. Time of task: about 60 seconds.
If It Meets the Following Criteria:
- It is covered
- It has an affordable copay
- It doesn't cost them money to fill
- It's not on the restricted "Aberrant List" (CVS/Caremark)
Great, they fill it.
If Any Or All of Those Criteria Are Not Met, They:
- Check EZSCRIPTRx's Therapeutic Categories for better alternative medications
- See a list of exactly what's available and covered under the Patient's plan
- Choose the best of the options for all involved (optimal coverage, low copay, profitable, readily available, etc.)
- Check coverage of adjunct therapy options that may improve the Patient's overall therapeutic results
- Most often the substitute medications are so close they won't need a Therapeutic Interchange form, but should they need one, they create one in less than two minutes using the "EZ TI Request" Tool
This EZ TI Request Could Include:
- One or more choices of alternative covered options
- One or more suggested covered adjunct therapies
The Therapeutic Interchange Request form ("EZ TI Request") is then sent directly to the Provider straight from the EZSCRIPTRx platform. The Provider simply checks the boxes of the alternative covered medications and/or therapies they'd like filled and signs the form, approving the interchange.
The Patient receives covered medications and therapies with low copays, that they would otherwise not have known were available to them under their benefits plan.
- The Provider sees that the Pharmacy is going the extra mile for them and their Patients (script after script)
- The Pharmacy is single-handedly improving adherence stats with every fill
- They've all but eliminated burdensome callbacks and the time and staffing those involve
- The more the Pharmacy incorporates this into their daily workflow, the more Patients are getting their (often more affordable) meds and receiving the care they need
- Being able to fill the majority of prescriptions they receive, reducing the staffing costs to do so, and offering adjunct therapy options where necessary, results in a direct, positive financial impact on the Pharmacy
- A financially healthy Pharmacy means they'll be there for the longterm to serve Patient's needs
Now with minimal effort, the Pharmacy has moved the needle for themselves, the Provider...AND most importantly, the Patient.
Small steps leading to significant gains for all involved. That is how we make an impact on healthcare...one Patient at a time.