The Impact of e-Prescribing Systems on PBM Formulary Management


Electronic prescribing systems can influence prescriber behavior and may result in lower prescription medication costs.

Selecting formulary medications decreases the financial burdens of patients and may lead to better patient adherence, according to a study published in the Journal of Managed Care and Specialty Pharmacy.

The researchers conducted an analysis of 1529 medication records, which showed the Electronic Health Record system (HER) and the Epocrates health software application provided accurate formulary information for 93.1% and 89.4% of medications, respectively.

Prescribers commonly use formulary medication coverage information generated by electronic health records (EHRs) with formulary decision support and mobile drug database applications, eg Epocrates, when making medication selection decisions.

The use of formulary medications has been demonstrated to improve patient adherence, possibly due to the lower costs to the patient. Nonformulary selections may lead to higher patient costs and nonadherence to prescribed regimens, as well as higher overall health plan spending, the study found.

Selection of nonformulary medications can also increase the workload of medical staff members due to more contact needed with dispensing pharmacies and paperwork generated by prior authorization approvals.

Electronic Prescribing Systems

Electronic prescribing (e-prescribing) systems such as EHR and Epocrates provide access to formulary information, and utilization management (ie, prior authorizations and step therapy). As these systems influence prescriber behavior and may result in lower prescription medication costs, it’s critical to verify the accuracy of these electronic formulary sources.

While previous studies have demonstrated positive outcomes experienced by physicians with direct access to formulary support, there are also reports that point to inefficiencies with e-prescribing systems, such as inaccuracies or formularies that are not up to date.

The study reported in the Journal of Managed Care and Specialty Pharmacy (April 2015) assessed the accuracy of insurance formulary status icons generated by the EHR system and coverage information found in the Epocrates mobile application. The study compared the accuracy of both sources to determine the most accurate electronic reference.

The study population included patients with Alabama Medicaid and Blue Cross Blue Shield (BCBS) of Alabama, the primary insurance providers in the state of Alabama. The study analyzed a total of 1,529 medication records.

The majority of medication records analyzed were for Medicaid patients (n = 1,227, 80.2%). Overall, EHR was more accurate than Epocrates (93.1% vs 89.4% respectively). In this analysis, the formulary information in the EHR was more accurate than Epocrates for these patients.

However, Epocrates was more accurate for patients with BCBS insurance than the EHR.


Accessing formulary medication information through e-prescribing systems can improve efficiency when the formulary information is up to date and accurate. Systems with formulary decision support can influence prescribers to prescribe medications that may be less expensive for patients.

Selecting formulary medications decreases patients’ financial burdens and may lead to better patient adherence.

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