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Pension and Employee Benefits: Code, ERISA, & Regulations
This series provides an authoritative and comprehensive reference to the full text of benefits-related provisions of the Internal Revenue Code, the full text of ERISA, and related proposed and final regulations, as well as the official IRS and DOL preambles, and Committee Reports.
from Spencer’s Benefits Reports: The potential for savings and improved outcomes by e-prescribing, in which a physician electronically transmits the patient’s prescription to the pharmacy, can be demonstrated in practice with some actuarial projections. This is the premise of an article by Susan Pantely, a consulting actuary for Milliman, published in the January issue of HealthWatch, a publication of the Society of Actuaries’ health section.
In the article, An Electronic Prescription for Health Care Efficiency, Ms. Pantely asserts that e-prescribing makes a doctor’s prescribing practice more efficient by helping the doctor make an “appropriate determination of the best drug for the patient” in a real-time fashion. To determine e-prescribing’s potential, an actuary can review doctors’ drug prescribing patterns and their generic proportions; that is, lower order rates for generic drugs shows greater potential for savings, she wrote.
As listed in the article, the advantages of e-prescribing using a hand-held device include the following:
1. It can make available the patient’s plan formulary to increase formulary compliance and thus lower the patient’s cost and the doctor’s prescription management time.
2. It provides up-to-date information on new drugs, available generic drugs, formulary changes, and prices.
3. It provides generic drug availability and other treatment options.
4. It promotes over-the-counter drug options whenever possible.
5. It avoids adverse events from drug interactions and multiple prescriptions from multiple prescribers, especially when used in conjunction with electronic health records.
6. It allows prescribing a highly effective optimal dose for each patient.
7. It alerts patients to missed prescriptions, either initial or continuing, and allows follow-up to improve medication compliance. This can work well with value-based insurance design, medical home-based strategies, or pay-for-performance strategies.
In order for e-prescribing to succeed, it is essential to have physician involvement and participation, user-friendly interfaces for prescribers, and complete medical information on patients, the article stated. While acknowledging that, without proof of its effectiveness, physicians might be reluctant to pay for an e-prescribing system and that insurers might pay for the expense, Ms. Pantely suggested that “a physician’s commitment to using e-prescribing is likely increased when they are responsible for the licensing fee” required for such systems.
“Widespread adoption of e-prescribing will likely be dependent on more detailed and accurate projections regarding the potential savings and improved outcomes of the early pioneers—information that actuaries are especially qualified to provide,” Ms. Pantely concluded.
For more information, visit http://www.soa.org.
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