Managing Prescribing Rules, Implementing Real Time Verifications into Workflow During COVID-19

The growth of telehealth, ongoing prescriber verification challenges, and the need for a universal patient identifier are all key issues that have arisen for pharmacists during the coronavirus disease 2019 (COVID-19) pandemic, according to a session at the virtual National Association of Specialty Pharmacy 2020 Annual Meeting and Expo on September 15, 2020.

During the COVID-19 pandemic, it has become even more difficult to keep up with the myriad changes occurring on a seemingly daily basis across the health care landscape, said Jill Regan, RPh, director of relationship management at LexisNexis Risk Solutions.

At the start of the pandemic, the health care community initially expressed concerns regarding the use of telehealth because of the Health Insurance Portability and Accountability Act (HIPPA) privacy rules. In response, a notification of enforcement discretion was issued by the United States Department of Health and Human Services Office of Civil Rights to empower health care providers to use widely available communications with applications.

As long as the electronic medium used to deliver services are via nonpublic facing applications and are HIPPA-compliant, they are cleared for use, including Microsoft Teams, Zoom for Healthcare, Amazon Chime, and GoToMeeting, Regan said.

In a US Centers for Medicare and Medicare Services memo regarding benefits, Medicare advantage organizations were allowed to provide Medicare Part B services via telehealth in any geographic area, including in beneficiaries’ homes. Further, the organizations may waive prior authorization (PA) requirements that apply to tests or services related to COVID-19.

Further, Medicare Part D sponsors must suspend all quantity and days’ supply edits under 90 days, relax “refill-too-soon” edits, and permit up to a 90-day supply in a single fill, while PA and step therapy requirements may continue.

Other changes that have occurred due to the COVID-19 pandemic, include an impact on controlled substance prescribing and how states are managing remote processing, telepharmacy, and extending licensure renewals.

In terms of real-time prescriber verification within operational workflow, prescriber data changes every week, according to John Heller, director of pharmacy sales at LexisNexis Risk Solutions. This information led to LexisNexis and Specialty Pharmacy Times to conduct the 2020 Specialty Pharmacy Survey to better understand the challenges of independent and specialty pharmacies.

The survey results showed that more than 20% of respondents lack the means necessary to update prescribers’ geographic data within pharmacy software. Although 60% of respondents said they verify their providers, 10% admitted to making no effort to validate any information. “While the DEA primarily focuses their attention on chain pharmacy, specialty pharmacy can still expose themselves to unnecessary risks and potential audits from either a state or federal licensing agency,” Heller said during the session.

Heller said the need for accurate provider verification is important, considering that 41% of pharmacists depend on inaccurate systems to verify a new provider and 50% do not update their data in real time. A real time prescriber validation maximizes claim results while reducing payer rejects, mitigating payer recoupment, and eliminating retrospective work, according to Heller.

These challenges are why universal patient identifiers (UPI) are foundational to interoperability and successful patient engagement, according to Erin Benson, senior director of marketing planning at LexisNexis Risk Solutions.

Implementing this kind of identifier into pharmacy practice can help create a golden record on each patient and eliminate duplicates. Additionally, UPIs can improve patient safety, simplify the ability to pull up the right patient’s record quickly, and decrease administrative costs. “

We believe there is a need to adopt UPI to achieve operational efficiency in pharmacy and improve patient safety,” Benson said.

Being able to cleanse and update patient information, along with improving data insights by understanding and helping patients overcome social determinants, can help health care professionals achieve optimal health outcomes and complete an overall shift to value-based care, according to the panel.

REFERENCE

Benson E, Heller J, Regan J. Managing Prescribing Rules Due to COVID-19, Implementing Real Time Verifications into Workflow, and Improving Interoperability. Virtual NASP 2020 Annual Meeting and Expo. Presented September 15, 2020. Accessed September 15, 2020.