Utilizing an Inter-Professional Approach to Enhance Patient Safety: Identifying Inefficiencies in PBM Prescription Processing




White, Annesha
Alba, Estela


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Background: Pharmacy Benefit Managers (PBMs) offer health plans a variety of services including negotiating price discounts with retail pharmacies, negotiating rebates with manufacturers, and operating mail-order prescription services and administrative claims processing systems among other services. The impact of PBMs on patient health is significant; therefore, it is important to understand the current challenges this industry. Objective: The objective of this study was to review the literature within the last seventeen years regarding inefficiencies in PBM prescription processing. A secondary objective was to discuss solutions to decrease error assisting patient in the mail order process. Methods: Journal articles were compiled through use of PubMed, Scopus, and Google Scholar using specific key terms. Articles selected for review were published from January 1, 1999 through May 1, 2016. This timeframe was selected based on the technological advances in the early 2000’s. The articles required information on current challenges and inefficiencies in prescription processing; particularly, articles pertaining to time efficiency, limitations, and future needs. Articles pertaining to pharmacy dispensing accuracy were also utilized as a secondary search and mainly focused on U.S. data. Results: Twenty articles were found, seven pertaining to the inefficiency in the insurance claim process and formularies, seven pertaining to prescriber outreach, and five pertaining to prescription data entry. Possible solutions explored for insurance claim processing were the access of prescribers to up-to-date and reliable formularies. Solutions discussed for prescriber outreach, were the further implementation of eprescription with more efficient features such real time tracking and messaging between prescriber and pharmacy. Additionally, for prescription data entry, synchronizing the eprescribing system so the prescriber can directly enter a prescription into the pharmacy’s system without the need of a technician having to repeat this step. Conclusions: Future trends reveal that e-prescribing will provide favorable outcomes to patients by decreasing inefficiencies in the prescription fulfillment process as well as decreasing cost. Patient safety will remain at the forefront as New York and Maine have already passed legislation mandating the adoption of eprescriptions. Healthcare team management of patients’ therapy and delivery are growing. It is imperative to address current and future challenges with the purpose to improve patient outcomes and satisfaction.