The Choice EMR is integrated with CoverMyMeds to provide prescribers with prescription price transparency and prior authorization fulfillment - all of which are free for medical practices.
Real Time Benefit Checks
The CoverMyMeds Real Time Benefit Check module provides prescription cost information at the time of prescribing. This unique algorithm provides the cost based on the patient's insurance, pharmacy, and drug selected during the prescribing process. This solution also identifies if a Prior Authorization is required and if a discount card might be available to save the patient some money.
Electronic Prior Authorization Module
For years, practices across the country have used the CMM ePA website at no charge to streamline the process of submitting Prior Authorizations on high-dollar medications to ensure patients can get the care they need. The Choice EMR - CoverMyMeds Electronic Prior Authorization (CMM ePA) module allows users to launch the CMM app from directly within OfficeMR. Once the app is launched, key data like patient demographics, provider demographics, and payer information can be directly populated into the ePA forms to reduce the burden of manually entering this data.
In order for the CoverMyMeds integration to work, a few things must be pre-configured. This article describes these requirements.
Product Setup
The CoverMyMeds integration can be turned on/off by adding a new product to the practice. This step can only be completed by the iSalus Support team. Please reach out to request this: support@isalushealthcare.com.
Company Settings
Decide if the Benefit Check option is enabled or hidden for your company: Run real time prescription benefit check (RxBC)
User Settings
Decide if the Benefit Check option is checked or not checked by default for your user: Run real time prescription benefit check (RxBC)
Our application has the ability to retrieve prescription cost information based on a patient/drug/pharmacy combination via the CoverMyMeds Real Time Benefit Check integration (RxBC). Once this feature has been setup for your practice, the following options become available:
Benefit Check Process
- Navigate to the EMR
- Open a patient chart
- Open the medications chart tab
- Fill out the prescription and select the desired pharmacy
- If you would like for a benefit check to occur, be sure the Benefit Check option is selected. If the product has been activated for your practice, this will be selected by default. Users can override this option by updating their user settings.
- If you would like for a benefit check to occur, be sure the Benefit Check option is selected. If the product has been activated for your practice, this will be selected by default. Users can override this option by updating their user settings.
- Click Send
- Before the prescription is actually sent, a benefit check will be displayed providing details on the expected cost.
- If you would like to continue sending the prescription, click Continue. Otherwise, click Cancel to make any necessary changes and restart the process.
Benefit Check Details
| Field | Description |
|---|---|
| Potential Pharmacy Substitution | This provides the drug most commonly dispensed at the pharmacy. This is a true representation of what the patient would experience at the pharmacy. For example, a brand medication is selected during prescribing but the Benefit Check may indicate that the pharmacy selected when receiving this brand medication would typically dispense a generic medication. This would provide the payment and coverage details for the generic medication. If ‘Dispense as Written’ is selected during prescribing, drug substitution will not occur. |
| Prior Authorization Check | Indicates if a Prior Authorization will be required by the pharmacy. |
| Plan Price | A single co pay amount will be returned when the plan/PBM is able to respond with an exact price In the event a single patient pay amount value is unable to be returned, historical pharmacy data is used to return a price range reflective of when the patient’s insurance is used. |
| Applied Deductible/ Remaining Deductible | The response has the ability to provide details around how much of the copay amount applies toward the deductible and what would be remaining of the patient’s deductible. |
| Cash Price | A price range reflective of what a patient would pay when not using their insurance. |
| Discount Price | The discount price field represents the price a patient would pay if they present the associated discount card to the pharmacy. A link will be provided that you must click to print off the discount card. |
In order for the CoverMyMeds Electronic Prior Authorization (CMM ePA) integration to work, a few things must be pre-configured. This article describes these requirements.
Product Setup
The CoverMyMeds integration can be turned on/off by adding a new product to the practice. This step can only be completed by the iSalus Support team. Please reach out to request this: support@isalushealthcare.com.
Roles
CoverMyMeds NPI User Access
The CMM ePA app allows users to manage Prior Authorization for NPI's that they have been given access to. This access is granted via the User Setup screen. You may need to enable this feature for Administrators.
- As an administrator, navigate to Setup
- Click Roles
- Search for "CMM"
- Select User Setup - CMM ePA Access
- Assign Write access to his screen to the necessary roles (usually Administrator)
- Save the settings
CoverMyMeds Task List Option
Decide if the CoverMyMeds option is available for a user to see in their Task List. This should typically be enabled for any user that will be accessing the CoverMyMeds application on a daily basis.
- As an administrator, navigate to Setup
- Click Roles
- Search "CMM"
- Select My Tasks - CMM ePA Access
- Assign Write access to his screen to the necessary roles (usually Provider, Ancillary Medical Staff, etc...)
- Click Save
User Setup - Assign Access to NPI's
For the users that will be working in the CMM ePA application, you will need to delegate access to the providers PA that they can work on. This is done by following the below steps:
- Navigate to Setup
- Click Users
- Select the user from the list on the left
- Select CMM ePA Access from the list on the right
- Assign this user to the providers that they can work PA's for
- Click Save
- Repeat steps 3-6 for each user that will manage PA's for your practice
Our application has the ability to integrate with the CoverMyMeds Electronic Prior Authorization (CMM ePA) solution to streamline the process of completing prior authorizations for medications. Once this feature has been setup for your practice, the following options become available:
My Tasks - CoverMyMeds
- Select CoverMyMeds from the MyTasks List
- Launch CoverMyMeds by clicking the button on the screen
- You will be signed into your CoverMyMeds account automatically or registered as a new user if this is the first time you have launched the program. Your user will have access to PA's based on the providers you have been assigned to. PA's can be added to this list manually or may be automatically sent here based on prescriptions initiated in our application.
- Learn more about the CoverMyMeds ePA App by opening the following user guide:
