| Many times people applying for health insurance | | | | systems. The functionality inherent in these systems |
| coverage exclude pertinent underwriting details during | | | | varies greatly depending upon the intended user such |
| the initial application process regarding an applicant's | | | | as physicians or case management. CPOE often |
| medical history or more specifically the utilization of | | | | includes clinical decision support (CDS). CDS during |
| certain prescription drug medications. Most often | | | | medication management regularly utilizes medication |
| prospective applicants think it is of no real importance, | | | | databases that provide drug interaction and dose |
| however a health insurance application which | | | | checking information during the initial phase of |
| disregards the proposed insured's current or previous | | | | medication prescription. |
| health status only to discover consumption of | | | | Transcription: Transcription utilizes pharmacy systems |
| prescribed drugs is indicative of high risk and could | | | | that help pharmacist process medication orders and |
| result in a declination. The list of medications scrutinized | | | | assist in pharmacy management. In addition, these |
| carefully by a health insurance underwriter is extensive | | | | systems often offer medication order checking |
| but the question most applicants ask is; how on earth | | | | through the use of pharmaceutical databases similar to |
| do they get this data in the first place? I wanted to | | | | those used during the prescription phase of medication |
| write this article so prospective applicants can better | | | | management. |
| understand and prepare themselves so they do not | | | | Dispensing: Dispensing of medications occur through |
| get rejected prematurely by an insurer but first lets | | | | the illicit use of a variety of hardware devices that are |
| take a look at the role two popular highly interoperable | | | | systematically tied to this integrated pharmacy system. |
| databases utilized during the underwriting process | | | | These include robots that pick single dose medications |
| work known as the Medical Information Bureau and | | | | and package them together for delivery to patients |
| Pharmacy Benefit Management. | | | | and dispensing cabinets located in inpatient areas that |
| By now most of the public already is aware about the | | | | facilitate the accurate picking of medications. These |
| Medical Information Bureau a non profit organization | | | | cabinets, containing the most frequently administered |
| who shares and exchanges applicant information to | | | | medications, use a visual cue, such as an automatically |
| member insurance companies. The Medical Information | | | | lighted tray or single opened drawer, to indicate to the |
| Bureau does not contain detailed electronic health | | | | nurse the location of the correct patient medication. |
| records in their repository collection such as EKG | | | | The cabinets use patient information, obtained manually |
| readings, Blood Test results, and other diagnostic test | | | | from the nurse and entered into a computer linked to |
| which could be of real significance and value to | | | | the cabinet or, more accurately, obtained electronically |
| insurance carriers. Instead the database contains | | | | from the pharmacy system, to drive the cabinet logic. |
| codes which serve as warnings in the medical | | | | Administration: Administration works to ensure the five |
| underwriting process and in most cases if the applicant | | | | rights of medication administration; right patient, right |
| has had group insurance for most of his or her lifetime | | | | drug, right dose, right dose, right route, and right time. |
| and has not applied for individual private health | | | | Systems employed during this phase often utilize bar |
| insurance there is a lack of communicable information | | | | coding of both patients and medications to ensure |
| and in which case the insurance carrier will most likely | | | | accuracy and tracking of medication administration. In |
| request an attending physician statement commonly | | | | addition to bar codes, radio frequency identification |
| known as an APS or the insurer will request a | | | | devices (RFID) tags are currently being deployed to |
| paramedical examination. Even will all these protocols in | | | | assist in medication management. The tags consist of |
| place to investigate the proposed insured there is still | | | | a microchip with an antenna that interacts with |
| the possibility that vital information is missing especially | | | | electromagnetic waves to exchange information. The |
| if the attending physician statement is missing | | | | capabilities of these tags vary from passive fixed data |
| documentation and records from an applicant | | | | devices to self-powered data modifiable chips. RFID is |
| prescribed medication from another practitioner of | | | | also used for tracking of both people and supplies. |
| medicine such as a specialist. There are many | | | | It is important to understand the side effect of all this is |
| databases used in health insurance underwriting and | | | | when you go to the pharmacy to pick up your |
| one being used more frequently today involves the | | | | medication this same preservation of system serves |
| usage of Pharmacy Benefit Management. | | | | its purpose to disseminate knowledge regarding your |
| A Pharmacy Benefit Manager is a Third Party | | | | condition to all HIPPA covered entities under the Health |
| Administrator of prescription drug programs. They are | | | | Insurance Portability and Accountability Act including |
| primarily responsible for processing and paying claims | | | | the clinicians, physicians, pharmacies, and Insurance |
| for medications. They are also responsible for | | | | companies. |
| developing and maintain the formulary, contracting with | | | | By now many of you readers are probably considering |
| pharmacies, and negotiating discounts or rebates with | | | | why all this information is even relevant. The reason I |
| pharmaceutical manufactures. The focus on | | | | am writing this article is to show you what is not |
| medication management promoted the deployment of | | | | registered in The Medical Information Bureau can often |
| a variety of interrelated systems. Generally, the | | | | be contained in the Pharmacy Benefit Management |
| medication management system encompasses four | | | | databases. Consider that certain medications such as |
| key areas: prescription, transcription, dispensing, and | | | | Cymbalta, Lexapro, Wellbutrin, Oxycotin, Limictal, and |
| administration. Prescription covers the writing of patient | | | | Lithium just to name a few are an immediate red flag |
| medication orders. Transcription includes the transfer | | | | to most insurers. Insurers will most likely approve an |
| of orders to generate review and formulation activities | | | | applicant if they can justify the usage of these |
| in the pharmacy. Dispensing encompasses the | | | | medications was situational on a particular |
| preparation of the medication for delivery to the | | | | circumstance like maybe depression because of a |
| patient. Medication administration covers activities | | | | death in the family or sever pain because of an |
| related to giving a medication to a patient. Lets look in | | | | accidental injury. What insurers worry about is drug or |
| more detail. | | | | chemical dependency and behavioral disorders that |
| Prescription: Electronic prescription occurs through the | | | | are eminent and progressive. |
| use of computerized practitioner order entry (CPOE) | | | | |