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ePrescribing and Self-Pay Patients

August 28, 2009
by Joe Bormel
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(graphic from Dr Eric Poon, presentation "Errors Associated with the Use of E-Prescribing", August 2008, highly recommended!)

Last night, a close family friend went to a night-time, walk-in clinic (run by a large, multi-hospital system) for what seemed like a lingering syndrome with elements of sore throat, sinus pain, mild neck pain, and the like. So far, a very common presentation. On examination, they found that she had some airway involvement and diagnosed bronchitis. Great diagnostic pick up! Our friend responded positively to a breathing treatment at the clinic and walked out stronger than she entered. Fabulous!

Here's where it gets interesting. They sent her home with a prescription for an antibiotic that has a retail price of over $100. There were three other prescriptions, for a net, out-of-pocket bill of about $300. Our friend happens to be a full-time student; although she has a modest form of health insurance, it will be weeks to months of administrative claims work before she'll even know what the final cost-to-patient will be. For now, it's $300 for the clinic discharge prescriptions for this effectively self-pay situation.

Now that universal e-Prescribing is destined, thanks to ARRA/HITECH, my question is, do any of the e-Prescribing solutions help the physicians write prescriptions that are both clinically and economically appropriate for patients? Do any of them inform the patient that Motrin 800mg tablets are almost free when taken as 200 mg ibuprofens? I haven't seen that kind of clinical/economic clinical decision support in commonly deployed e-Prescribing. I hope it's out there and we should draw attention to it, as HCIT professionals.

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