Smarter Decisions, Superior Outcomes

How Formularies Make an Impact

Posted by Denika Hockenhull on September 29, 2016 at 9:05 AM

Over the past few years, prescription drug costs have risen in a dramatic fashion. According to a federal report released this spring, prescription-drug spending rose 12.6% in 2014 and spending is expected to rise 7.3% a year through 2018. The increased cost is most closely associated with the influx of specialty drugs—high-cost prescription medications used to treat complex, chronic conditions. Rather than offset these prices, generic drugs costs are also experiencing an increase in price adding to the prescription drug cost burden. Drug utilization and the increasing cost of prescription drugs for members who require these medications as maintenance therapy is constantly in the forefront of discussion.

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Topics: patient outcomes,, drug costs,, formulary,

3 Types of Data to Help Make Provider Decisions Smarter

Posted by Kathleen Sabo on August 15, 2016 at 11:00 AM
With a wide range of patient information collected throughout hospitals, physician’s offices, and medical and pharmacy claims, we have seen an unprecedented amount of information waiting to be used by physicians and providers alike. Healthcare providers need accessible data to make the best clinical decisions at the point of care. But quality healthcare depends on the quality data.
Quality data allows for more accurate diagnoses, more effective treatment strategies, and provide higher quality service overall. In this article, we examine three valuable sources of data that every provider should leverage in order to make smarter decisions.
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Topics: Meaningful Use, data sharing, EHR, provider workflow,, data quality

Balancing Effectiveness and Cost of Specialty Medications for Treating Complex Conditions

Posted by Denika Hockenhull on June 1, 2016 at 10:00 AM

Spending on specialty pharmaceuticals climbed 18 percent in 2015, compared to an increase of less than 1 percent for standard prescription medications. The burgeoning outlay comes as no surprise considering the hefty price tag of these new drugs, with some reaching upwards of $60,000 for a course of treatment.

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Topics: pharmacy spend, Specialty Drug Cost Control, Specialty Drug, patient outcomes,, biosimilars, interchangables,, drug costs,, rising drug costs,

Monitoring PDMP Effectiveness Now and in the Future

Posted by Denika Hockenhull on May 16, 2016 at 10:30 AM

HID had the honor of leading honored a Vision Session during the 5th Annual National Rx Drug Abuse & Heroin Summit that was held March 28-31 in Atlanta, Georgia.

Titled “Monitoring PDMP Effectiveness Now and in the Future,”  HID’s presentation focused on how data accessibility and enhancement are effective tools for protecting public health and safety while supporting sound clinical prescribing, dispensing, and use of controlled substances. Attendees discovered:

  • How collaborative partnerships support state PDMP goals and outcomes
  • Why public and private health plans will require PDMP data
  • How the ONC’s Interoperability Roadmap will change the way PDMP data is accessed

Program Manager Rebecca Poston, MPH, RPH, was on hand to speak on the tremendous success accomplished by E-FORCSE, the State of Florida’s PDMP. E-FORCSE has experienced real, tangible, positive outcomes since 2010 when the program began and HID’s RxSentry solution was implemented.

If you've missed this year's Summit, don't worry. Our team has provided the presentation slides and a brief recap after the jump!

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Topics: Interoperability, state health, opioids, PDMP, population health, healthIT, data accessibility

Why Health Plans Need PDMP Data

Posted by Denika Hockenhull on May 2, 2016 at 9:00 AM

It’s an inescapable truth that, in healthcare, data matters. For health information technology innovators, data is the window inside a lifecycle of a service, product, or application that can be analyzed for improvement. For providers, data helps the accuracy of diagnoses and creates more effective treatment paths. Health plans benefit from data as well. For plans, data builds actionable information and insights, two important steps in the balance of managing risk for each plan and enhancing outcomes for each member.

Health plans need access to information sources that help build for the future. But this need goes beyond simply connecting to the traditional repositories that capture and store large amounts of information. To optimize our understanding of users, patients, and members, plans must have access to sources beyond claims data. Expanded data sets from non-traditional sources will benefit plans with the right tools to manage collection and analysis.

One such non-traditional, underutilized source is prescription drug monitoring program (PDMP) data. Since the adoption PDMPs, these electronic database systems have amassed a decade’s worth of information regarding prescribing and dispensing behaviors of controlled substances as well as information that can be used to develop baselines for analysis or to monitor trends. There is an industry-wide need to make PDMP data accessible, building towards the goal of creating outcomes-based healthcare.

Building upon current frameworks of data sharing and utilization, we identify the opportunities in which PDMP data can help health plans in the future.

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Topics: pharmacy spend, opioids, prescription drug monitoring, PDMP, health plan management, controlled substances

How Will the New 'Orphan Drugs' Affect Pharmacy Expenditures?

Posted by Kathleen Sabo on February 19, 2016 at 12:08 PM

In recent years, the pharmaceutical industry has experienced slowing growth on a global scale, due in part to patent expirations, increasingly tough regulations and fierce competition from generics. One sector, however, has not suffered the same fate—specialty pharmacy.

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Topics: High Cost Medications, Controlling Pharmacy Expenditures, pharmacy spend, orphan drugs, Meaningful Use, Coverage Determination Process, Prior Authorization, Specialty Drug Cost Control, Specialty Drug

4 Essential Keys to a Solid ePA Knowledge-base

Posted by Kathleen Sabo on February 2, 2016 at 8:30 AM

ePA will continue to gain momentum.

Electronic Prior Authorization (ePA) is not going anywhere—and, we're not talking about the folks who test drinking water and lobby for reduction of air pollutants. There has been a lot of talk about ePA over the past year. In fact, Google records nearly 3.9 million results for the term and nearly every week there is a legislative update, industry news story, or forum on the topic. Don't expect that to change this year.

With benefit managers struggling under the weight of requirements from Federal rules like HIPAA, HITECH, and Meaningful Use, as well as State regulations, ePA has become an essential strategy for the evolution of pharmacy benefit programming and maintaining regulatory standards. However, the value of ePA reaches much further than compliance. ePA substantially increases efficiency in the continuum of care for everyone, including providers, dispensers, patients, health plans, and payors. Faxing forms is cumbersome and depends on old, outdated technology. With ePA, a determination can be received in just minutes, often times when the patient is still in the doctor's office. And, this value is what providers have been waiting for.

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Topics: Interoperability, NCPDP Standards, ePA, Meaningful Use, Coverage Determination Process, Prior Authorization, Interoperability Roadmap

Controlling Specialty Drug Spend through the Coverage Determination Process

Posted by Kathleen Sabo on January 26, 2016 at 8:00 AM

iStock_000016535503Large-1.jpgAccording to United Health Center for Health Reform and Modernization the United States spent $87 billion on specialty drugs in 2012, and that number is estimated to reach $400 billion by 2020. In 2014 alone the cost of specialty products alone has risen 13.1%. Specialty drugs now cost more than the median household income.

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Topics: High Cost Medications, Controlling Pharmacy Expenditures, Coverage Determination Process, Specialty Drug Cost Control, Prior Authorization Processing

Independent & Objective

Clinical expertise without the noise

Getting the facts matters. Following our corporate mission, we're committed to using this blog to enhance your knowledge of evolutionary events and discussions in the pharmacy services and technology arena. 

Here's what we're focused on right now:

  • Lowering ingredient cost
  • Enhancing the coverage determination process
  • Creating robust prior authorization criteria
  • Producing actionable drug trend analyses
  • Enhancing prescription drug monitoring 
  • Implementing interoperability efforts

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