SureScripts Update

Rx Eligibility: 

You can check which pharmacies the patient has active coverage with to help you make the best pharmacy selection for this patient. 

Accessible from the Rx Bowl or Rx Order screen

How it works: 

The system will do an automatic eligibility check everyday at 1 AM practice time zone for all appointments scheduled that day.

• If the encounter is is in the status of canceled, rescheduled, no-show, pending co-sign, or signed off the system will not check Rx eligibility. 
• Can only check once every 3 calendar days. 

The eligibility request sends patient demographics (first name, middle name, last name, suffix, DOB, gender) to SureScripts. Surescripts matches patients in its database then routes to a Pharmacy Benefit Manager (PBM), an intermediary between insurance companies and other members of the health care industry. 

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Medication History: 

The system will display a patient's dispensed prescription history for up to the past year based on SureScripts overall and not just your practice. 

How it works: 

From the Rx Bowl click on the clock icon to review the patient's dispensed Rx History. A disclaimer (SureScripts requirement) will pop up the first time, Dismiss or click Do Not Show Again. Check eligibility then have the patient sign a consent to obtain medication history. The consent can be found right from the Rx History screen or anywhere unsigned consents are available (alerts, appointment card, etc.). Refresh (pull down on the screen) and you'll see under Dispensed tab medications previously dispensed shown with diagnosis, date, pharmacy. 

Notes:

• The prescription history can only be retrieved once per day (CT).
• Eligibility needs to be approved for check to run
• Consent needs to be signed
• If the prescription name is blue the drug is a controlled substance.
• Dispensed prescription history can also be found under Chart > Rx History 

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Formulary Module: 

Formulary information for prescribed prescriptions will be displayed in the Rx screen. 

How it works: 

An eligibility request needs to be approved for at least one PBM for formulary request to be sent to SureScripts. If more than one PBM is approved you'll see the formulary information for each PBM under the prescribed medications. 

If there are alternative medications you'll see a watermarked number in the bottom right corner. You can click on that or the hyperlink with the number of alternatives to review and swap selections. If you want to select one of the alternatives, swipe from right to left over the medication > prescribe. 

Notes: 

• Unknown, Non- Formulary, or Not Reimbursable: if you see these statuses it means that the medication most likely will not be covered by the payer and you might want to seek an alternative or the patient will need to pay the full amount.
• Type of medication can be generic or branded. 
• Rx or OTC (Over The Counter) also provided as basic formulary information
• "Unkown Formulary Status" will be displayed under the prescription if no active coverage. 
• Copay information can be expressed in tiers for each pharmacy type or flat dollar amount or combination. Out of pocket amount and minimums/maximums can also be applied. 
• Prior Authorization requirement can be listed
• Quatity, age and/or gender limit can be identified 
• Step Therapy listed if needed