Rx Hub
TouchWorks EHR has been receiving medication history from the PBMs participating in Rx Hub since V10. However, V10 couldn’t handle the feed well so the information was blocked. AHS is currently blocking the rest of the PBMs, but there is the capability of receiving all PBMs that participate in eligibility checking. They are:
- Caremark
- Medco
- Argus
- Aetna
- Pharmacare
- ESI
- Wellpoint
Plan information from the PBMs will not be populated, and some of the PBMs won’t pass medication history for things like HIV drugs or Psych meds. If you turn either the flag to receive the Aetna feed on or remove the filters for the other PBMs, it’s an all or nothing thing. You can’t break it out by practice as this setting is at the Enterprise level. Eligibility checking occurs every 30 min and looks at all patients with a scheduled appointment and updates accordingly. Aetna, specifically, goes back through 18 months of claim history and loads medications with the following logic:
- 1) Provider is within the org: it updates the medication list if it doesn’t appear, but doesn’t make any changes to a medication that is a refill (like HCTZ).
- 2) If the medication was prescribed by a provider outside of the organization it places the medication it changes the status to Unverified.
AHS is currently working with SureScripts and Rx Hub to expand the PBM checking features. SureScripts can provide information from pharmacies to provide medication feeds; this would be beneficial in cases where an insurance claim wasn’t submitted, so it wouldn’t populate from Rx Hub.