Nurses play an integral role in a patient’s health care journey, often spending more time with patients than the physician. This puts the nurse in an optimal position to assist patients at the point of prescribing and beyond.
CoverMyMeds recently conducted a survey of over 400 nurses to better understand nurse behavior, authority, pain points surrounding patient prescription decision support and their role in medication access. In their responses, nurses focused on several specific trends. Evaluating and closing the gap on these trends can better support nurses as they remove barriers and create a path for patients to get the medications they need.
Whether part of the job description or not, many nurses spend time finding medication information for patients. Most are using multiple resources to find this important information primarily because it has historically not been located through a single, trustworthy source. They’re usually looking for this information after prescriptions have been sent to the pharmacy.
More than half of them are using online medication resources, and 80 percent are doing this at least a couple times each week.
Medications covered under a patient’s health plan vary depending on the plan’s formulary. This information isn’t easy to keep track of, especially when medication requirements can change. In the words of one oncology nurse surveyed, “It’s all very confusing and frustrating. I often spend more time being a medication concierge than a registered nurse.”
Ninety-seven percent of nurses surveyed said they are providing medication information to their prescriber(s). Common reported examples include prior authorization (PA) requirements, symptoms and allergies, patient medication history and patient plan formulary information. While most of these interactions are in person, more than half of nurses said they also interact through the EHR where questions and tasks require a physician response. The more attentive the prescriber, the better the communication can flow from nurse to provider to patient.
“Prior authorizations for medications take up way too much of my time each day,” said one gastroenterology nurse surveyed. “I don’t feel like a nurse anymore. I feel like a ward clerk.”
Out of ten core responsibilities identified in the survey, one of the lowest satisfaction levels reported was with PA. It usually falls on nurses to initiate conversations with patients about PA requests, and most feel it is their responsibility to find alternatives – usually after the prescription has been sent to the pharmacy and a rejection returned.
Real-time benefit check solutions can surface PA requirements for certain medications earlier in the workflow, and some at the point of prescribing. This allows prescribers to initiate prospective requests and relieve some PA burden, allowing them more time with patients.
Unfortunately, prospective PA isn’t always a possibility, due to medication choice or solution availability. Nurses are in contact with pharmacies during the day for prescription status updates, PA status updates, medication availability and for alternative medication information. This game of telephone can be a time sink – only 29 percent of nurses surveyed reported feeling satisfied with the length of time spent on pharmacy phone calls.
Some of this time could be avoided with solutions at the point of prescribing that can provide formulary alternatives, or patient choice solutions that could resolve prescriptions not covered by insurance at the pharmacy.
Do most patients know which medications they’re taking? Over 40 percent of nurses surveyed reported less than half of their patients don’t. In fairness, it is a lot to keep track of – nearly half of respondents said most of their patients are taking 6-10 different medications.
Also critical to the patient journey is medication history, specifically tried and failed medication information. This data can be used to build a case for PA requests for non-covered medications as well as future therapy plans. Ninety-four percent of survey respondents are digging through previous documentation to find medications the patient has previously tried and failed. This is more administrative time spent scavenging for data that could be collated and listed in an efficient solution built into an EHR or workflow tool.
“It’s very difficult to keep up with rules that can change daily about medications, especially with Medicare patients,” said an oncology nurse surveyed. “Each insurance company requires a different medication, a different form for the same medication, and if it’s Medicare but the same insurance company, even a different form.”
Benefit formularies can change at any time, but there are often not processes in place in health systems to update this data. This leads to a pharmacy traffic jam of rejected claims and subsequent paperwork and phone calls to find a way to cover the medication – or to find an alternative. This work often lands on – yes – nurses.
Through direct connections with payers, reliable point-of-prescription solutions can update formulary and benefit information in real time, preventing later hassle.
When health care staff exhaust all avenues for accessing the originally prescribed medication, the next adventure begins: finding a suitable, accessible alternative. Most nurses feel responsible for this task – 75 percent of those surveyed said they feel responsible for finding covered alternative medications and financial assistance options if cost and/or coverage are issues for their patient. It was the second-most cited reason nurses said they contacted the pharmacy. By the time they are searching for alternatives, they have likely already been through a round of phone calls and paperwork about the medication not covered or rejected by the plan. Nurses and providers would have fewer workflow interruptions with medication alternatives provided within a payer-connected, pharmacy-supported solution.
Nurses can feel pulled in many directions, sometimes to the extent of feeling like they’re in a different role entirely – “ward clerk” and “medication concierge.” Because their skillset varies wildly, actual job expectations can become unclear, leaving nursing staff to feel overwhelmed in some cases . Nurses in the survey reported lower satisfaction for administrative responsibilities when it resulted in less skill or knowledge-based patient care.
Clear delineation of job responsibilities and understood, measurable outcomes puts nurses, and any employee, on a more satisfying job path. Some health systems have found success in creating a centralized PA team where all prior authorization and insurance interactions are funneled.
Surveyed nurses reported using various types of technology throughout the patient journey. More than half of nurses reported using applications outside of their EHR at least once per day, with nearly 20 percent reporting smart phone use after the patient left the office.
Nurses are going outside their EHR to find information to help their patients access medication. They are going out of their way and finding technology workarounds because their current workflow solution is not adequate to find the data they need to best help their patients.
Nurses are positioned as the biggest patient advocates on the health care team, finding everything from discounts on medications to the best second choice when the prescribed medication can’t be obtained. They need smarter, reliable solutions with accurate, updated medication and benefit information – in one place. By empowering these caregivers, they can better influence the best medication decisions. This helps patients get on, and stay on, the medications they need and helps bring job satisfaction to a strong nursing workforce by decreasing administrative burden and allowing them to provide direct patient care.
In the words of one nurse surveyed, “I remain hopeful for a more streamlined process of communication between insurance companies, pharmacies and providers so that patients receive quality care in a more timely manner.”