In the ever-changing world of medicine, physicians are constantly adapting to best care for our patients. Recently, I realized that e-prescribing had become a bit of an art form. Here are a few tips you may find useful.
1. Use your formulary data to prescribe what you want to prescribe. I try never to compromise with my prescriptions, and I generally assume that my medicine of choice will be covered. With e-prescribing, if there is a formulary problem, I may get a call back the same day when the patient encounter is still fresh in my mind. Better yet, I have found the formulary data provided by my electronic medical records (EMR) system to be accurate and useful. So, I can usually tell right then and there that my preferred medicine will get covered. If you typically prescribe a generic out of fear that your preferred brand-name eye drops will not be covered, you may be able to use formulary data to prescribe your branded medicine of choice more frequently.
2. Pharmacy notes! In many e-prescribing platforms, the physician can write free text notes to the pharmacist. This option can make everyone’s life easier. I will write "90-day supply OK" and let the patient and pharmacist work the rest out. Or, perhaps for a medicine like cyclopentolate, I will write "OK to give 2% if 1% not in stock." You can also communicate regarding back orders, coupons and insurance coverage.
3. Communicate with your patient and set expectations before they go to the pharmacy. "The medication I have chosen for you is, in my mind, the best one. If it is unaffordable, we can work around it. Otherwise, I'd like you to have this medicine." That phrase goes a long way, especially in an era where pharmacists are financially incentivized to change your patient's scripts in manners that are more beneficial to the drug plan than they are to the patient.
4. Ask your patients how much their monthly eye drops cost. You will be consistently surprised, in unpredictable ways. With this question, I have found patients paying hundreds of dollars monthly for generics (that would likely be less money without a drug plan) and I have met patients who pay next to nothing for several premium brand-name eye drops. Asking patients what they pay can help you make sure that your patients aren’t being taken advantage of, and it can help you get your patients on the best therapies allowed by their plan.
5. Patients who have frequent pharmacy errors would probably be better off with laser. I think most patients are allowed to have a mulligan or two when it comes to failing to get a medication filled. However, at the end of the day, after two or more situations where a patient is unable to be treated because of some problem with the pharmacy, it makes sense to have a laser insurance plan, and that is exactly how I describe it to the patient. Therapeutic lapses often results in high intraocular pressures, and that is when progression occurs, and patients who for whatever reason have trouble getting their medications from the pharmacy should not go untreated because of this. Selective laser trabeculoplasty fits ideally into this situation.
In summary, the pharmacy is, in a sense, a treatment modality, and one that mean we may use wisely or poorly. Hopefully these tips help get you closer to your ideal treatment paradigm.
Dr. Nathan M. Radcliffe is a clinical associate professor of ophthalmology at New York Eye and Ear Infirmary and is a cataract and glaucoma surgeon at the New York Eye Surgery Center.