Drug Plan and Formularies

Set Medicare Drug Plan

For Medicare Part D formularies to show up when you prescribe a medication, you must have a valid Medicare Drug Plan chosen in the patient’s Meds tab. In the patient’s Meds tab, click on the underlined link named Medicare Drug Plan which is located underneath the Preferred Pharmacy & Mail-In Pharmacy choices.

When you click Medicare Drug Plan, it will open a Locale & Plan Name screen. It opens to the selection of state/county that your system is set to default to.

First you must select the correct State and County of the patient’s primary residence using the drop-downs. The geographic location is important because a Medicare drug plan by the same exact name can have different coverage in two neighboring counties. When you select a state, the appropriate county names for that state will show up in the county drop-down. Once you’ve selected the State & County for the patient, begin to type the name of the drug plan they have. The system will auto-complete choices for you to select from. These drug plans are updated regularly when we receive updates from CMS. Their corresponding CMS#’s will follow the name of the drug plan. These CMS#’s can be found on the patient’s card. This will help ensure selecting the correct drug plan coverage for the patient.

Click the SET button to set this state/county/plan information for the patient. Click the clear button if you made a mistake and it will erase all fields to start over.

Once you’ve clicked SET, the Medicare drug plan including CMS#, along with (state/county) information is stored for the patient in their Meds tab.

If a patient has a chosen Medicare drug plan, then Quick Prescribe can display formulary information. When you have set a drug plan for the Medicare patient, you can begin to prescribe and see formularies for them.

Change or Delete Saved Medicare Drug Plan

If the patient no longer has a Medicare drug plan, yet one is stored in the patient’s meds tab, simply click on the underlined Medicare Drug Plan link in the patient’s meds tab.

The locale/plan fields open. To change to a different/new Medicare drug plan – make sure to select the right state/county and plan name. Click SET and it will now save as that Medicare drug plan.

To delete a Medicare drug plan entirely and save as Not Selected (say a drug plan was entered in error for a patient, or the patient now has a different drug plan and it’s not Medicare Part D so we don’t store it), then here at the local/plan fields, click the CLEAR button. All fields will be cleared. Then click SET and it will store the Medicare drug plan as blank and will say ‘Not Selected’ in the patient’s meds tab.

Medicare Drug Plan Formularies in Quick Prescribe

After having a Medicare Part D formulary set in the patient’s Meds tab, click on Quick Prescribe link to prescribe a medication for a patient.

Type in the name of the medication you are prescribing and the system will auto-complete valid medication names from the First DataBank database. When you select medications from this auto-complete choice listing, the drug/allergy interactions/warnings will be on and you will be notified on the screen of any interactions/warnings. (See other help documentation named Prescribing & Adding Meds) After you have selected a medication, tab to the Form field which is next. If the medication is covered under the Medicare drug plan, the form will be bolded in blue along with the tier that they fall into will be displayed. These are forms of the medication that are covered under that patient’s drug plan. Lower tiers (ex: Tier 1) are generic and usually cheaper. Some plans have up to 7 tiers.

After you’ve selected a covered form with tier info on it (which is bold blue choices with Tier listed on it), you can tab to the next field and continue to fill out your prescription.

Enterprise Health uses the First DataBank knowledge database to display “AB rated equivalent” generics in the drop-down selections for “form.”  If the generic is chosen, the medication will be switched to the generic form for the brand in the final prescription. To see the Medicare formulary, a little image with an “f” in it will appear beside the auto-complete if you chose a tier. You can click that to bring up pricing information based on 30 day or 90 day supply, and also for different coverage periods (initial, gap, catastrophic).

If you choose a black form choice (no tier info on it), that means that form is not covered under that Medicare drug plan and you can continue prescribing the medication, but the drug plan does not cover that selection. When you click on the (f) formulary icon next to a selected tier form, it will open the formulary screen for that selection.

There are many help icons you can click on that will pop up explanations of columns/choices/non coverage’s, etc.

There are plans which have a $0 copay for Tier 1 drugs, so that would show $0.00 for the amount. Click the CLOSE button at the bottom to close the formulary screen. The Medicare Prescription Drug Plans & Medicare Advantage Prescription Drug Plans & Formularies in the system are updated automatically when we are notified of changes by CMS (Centers for Medicare & Medicaid Services).

Drug Guides Sidemenu

You can also display formularies, tiers and other information from the sidemenu tab named DRUG GUIDES. When you are looking up a drug in the drug guide, you can search by a Medicare drug plan and display on your screen the formularies, tiers and choices for that particular drug you are searching.