SmartAlts™ are therapeutically similar drug alternatives displayed at the time of prescribing within an Electronic Health Record (EHR) or other provider tool. It enables prescribers to select the best clinical and cost-effective medication for the patient to improve health outcomes, make prescribing more efficient and improve patient and provider satisfaction. SmartAlts™ are suggestions for alternative options to achieve similar results to the medication you are currently prescribing. The dose ranges provided are based on head-to-head studies or similar package insert dosing recommendations for therapeutically similar drugs while taking into consideration those products which have restrictions like prior authorizations and/or other higher costs.
SmartAlts™ are provided in conjunction with other member benefit information at the point of decision. This enables a discussion with the patient regarding other options that would be covered by his/her health plan as the overall most cost-effective option. This will alleviate the issues of potential delays to therapy due to cost, formulary support, or coverage restrictions.
The most common way to see SmartAlts™ is when you are prescribing a drug in your EHR. For example, within your workflow during drug selection, the EHR will display the drug’s formulary & benefit information . If the drug selected has more cost-effective formulary options, SmartAlts™ will appear either on the current screen or as a pop-up on the next screen when selecting the drug. SmartAlts™ enhanced intelligent formulary information provides better information about formulary status, cost and prior authorization status to improve the prescribing process and ability for patients to afford their medications with no surprises. SmartAlts™ are currently available for patients whose health plans leverage the intelligence of Benmedica’s provider decision support.
SmartAlts™ leverages the existing Surescripts connection that already exists in most EHRs. The information including the formulary & benefit enhancements should appear automatically in your EHR’s e-prescribing workflow for participating health plans.
SmartAlts™ replaces previous “noisy” drug alternatives provided by most PBMs (Pharmacy Benefit Managers) and EHRs. They are intended to reduce confusion by only presenting better formulary alternative options that are therapeutically similar drug alternatives versus large lists of drugs in the same therapeutic class. The goal is to reduce provider burden, save you time, save the patients money and get on therapy more quickly.
They save time by providing accurate, actionable information up-front to alleviate the guess work in your decision-making process and reduce patient callbacks to your office.
SmartAlts™ are drugs that are more formulary preferred therapeutically similar to those that you initially ordered. They are a curated list that is updated weekly. The ultimate decision is always yours to prescribe the best drug for your patient and other medications/conditions that need to be considered.
An estimated cost for each alternative included in the SmartAlts™ list is provided. All alternatives will have a better than or equal formulary status with most alternatives being more cost-effective and less prior authorizations than the originally selected product.
The prescribing clinician is ultimately the best person to decide the ideal drug and dose for patients given all clinically relevant considerations around the drug chosen.
The therapeutically similar alternatives provided in SmartAlts™ are intended as information related to the patient’s drug benefit only. You should use your clinical knowledge and expertise as you always do related to clinically relevant criteria or contraindications for those alternative drugs.
SmartAlts™ are for information only. Prescribers have the ultimate decision regarding which medication to prescribe.
New Drug Change lists are reviewed weekly. Drugs are added, deleted or modified into SmartAlts™ accordingly.
Feedback is highly encouraged and can be provided by going to info@benmedica.com.
SmartAlts™ alone does not currently integrate other Drug Utilization Review, such as drug-drug interaction or allergy notifications. Most EHRs and pharmacies perform this service. Oversight of DUR is ultimately the responsibility of the prescriber and pharmacist.
Some SmartAlts™ are dosed in accordance with some pediatric and geriatric dosing when appropriate. You are advised to exercise your usual caution for special populations.
The NCPDP Formulary & Benefit v3.0 standard enables payers to present formulary status at the point of decision. Most formulary status values such as “non-formulary” or “on-formulary, not preferred” are a single value. The one value that allows more differentiation is the preferred level. A payer can use a value from 1 – 97 where a higher value indicates a more preferred product. Due to payer inconsistencies, some payers choose lower number formulary status while others use the high numbers, a variation of the previous formulary statuses, or a larger range such as formulary status preferred levels 1 – 35. The larger ranges may be used to represent effectiveness, cost, or clinical considerations. The rule of thumb is that the higher the value, the more preferred and more recommended the product is. For example:
That’s the way the NCPDP Formulary & Benefit standard was created in the early 2000s. It was easier to manage formulary preferred levels by making more preferred drugs a higher value. The next version of NCPDP’s Formulary & Benefit standard (v60) will be addressing the confusing usage of preferred drug levels by changing the value of importance so lower values are more preferred, like drug tiers. Lower will be better for all formulary and benefit values.
Tier 0 is used to represent drugs on the prevention tier with a $0 copay. Some plans may also use this value to represent other $0 copay benefit designs.
Every EHR is certified to indicate if there are any messages or web links. Messages may be displayed or may require to hover or click to see the information. Weblinks may be active or require you to copay and paste the URL into your web browser.
RTPB integrates within your EHR. When you create a prescription for a patient and before you send it to the pharmacy, RTPB can confirm the previous F&B information at the patient level and provide actual drug prices based on the pharmacy selected as well as if the drug has 90 day retail and mail options.
Formulary & Benefit provides the patient’s drug benefit information at the benefit level. It does not reflect the patient status with his/her deductible or if drugs have been approved for prior authorization. Real Time Prescription Benefit (RTPB) is at the patient level. It can confirm that a PA may not required as well as the cost of the patient’s prescription at the selected pharmacy and often at mail order too.
F&B is like a Google search with results and RTPB is up to date information specific to the individual patient. In ePrescribing, Formulary & Benefit provides formulary guidance, presents copay and warns about coverage restrictions. It also can provide lower cost drug alternatives than the initially selected drug to prevent rework and pharmacy callbacks. This is especially useful in the prescribers’ favorites prescription list. After a drug is selected and a prescription is written, RTPB provides the cost of the drug and recommends lower cost drug alternatives with their prices.
F&B only needs to confirm who covers the patient to display formulary and benefit information. RTPB needs more information than F&B. It not only needs to know who the patient is but also the drug, pharmacy, quantity, and days supply in order to return the expected prices and any coverage alerts. This occurs near the end of the prescribing process making rework more frequent.
F&B supports step medications. If a payer chooses, it can provide drug groups and the number of drugs to fail in order to get the flagged drug covered. RTPB does not currently support step medications.
Surescripts, the nation’s largest e-prescribing network has a list of vendors that have been certified. You can confirm if your software supports e-prescribing here. If you see your EHR is certified but you are not seeing F&B, then contact your administrator to confirm that it is activated. Some EHRs need to turn-on the functionality.
Surescripts and other networks certify EHRs comply to certain usability rules when supporting formulary display. In short, an EHR must display formulary status, copay, alternatives without clicking, hovering or scrolling. An exception is made for drug alternatives since they frequently do not need to be displayed since the initially selected drug is already a preferred drug. Coverage information must be indicated. For example, there must be a symbol or hover to see the information. Obviously, they can be displayed in their entirety too. If your EHR is making F&B display difficult, please contact your vendor.
F&B is based on the patient benefit design and not where the patient is in their deductible spend. It does not necessarily take into account the patient’s deductible though it could. If payers chose, they could support multiple copays that reflect each stage of the benefit design. For example, 100% copay till deductible is met then $40 for the selected drug. That said, most PBMs just provide the benefit design copays.
Pharmacy networks are currently not supported though a payer could include a message in the F&B if the message did not exclude any specific pharmacies to avoid steerage issues. The next version of F&B will support pharmacy networks.
