Pharmacy eVoucher and Denial Conversion Services – Essential Tools to Help Patients Obtain Prescribed – and Preferred – Medications

A survey conducted jointly by National Public Radio, the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health found that although most Americans have insurance that includes prescription drug coverage, more than one-third of adults said that either they, or a member of their household, were denied coverage for a prescribed medication in the past year. 

Pharmacists, of course, understand the frustration and heartbreak of not being able to provide a patient with their doctor's first-choice medication. Pharmacists also understand that more times than not, these patients will simply choose to go without their medications. And when that happens, treatable conditions often escalate, resulting in the need for hospitalization and other types of high-costs medical resources.

Now though, there are ways for pharmacists to intervene and help patients receive their prescribed medications. Two specific technology-based solutions are now available and helping to facilitate patient access to medications. These solutions, both available to private, non-government plans include: 

• eVoucher services which locate and apply manufacturer copay discounts at point-of-sale, enabling patients to reduce their

  out-of-pocket costs. eVoucher capabilities generally work as follows:

          • A pharmacist receives a patient's prescription and enters key information into the pharmacy's technology system.

          • The prescription information is routed to the appropriate plan/payer via the pharmacy's technology system (such as PrimeRx™

            from Micro Merchant Systems.) Information is returned to the pharmacy regarding formulary coverage, patient co-pay amounts,

            prior authorization requirements, and any step therapy protocols.

          • AT THE SAME TIME THOUGH, eVoucher capabilities determine if the manufacturer of the prescribed medication offers a voucher

            to help offset the patient's out-of-pocket costs.

          • Should an eVoucher be available, the system will notify the pharmacist of the revised co-pay amount, and automatically adjust the

            patient's account.

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