Why Blending Rx and Dx Data Matters

Yesterday at the PBMI conference, I was listening to a presentation on the blending of pharmacy and medical data. This has been the Holy Grail for a while although companies have struggled to do it well and successfully use it to affect change. That being said, I think it’s one of the biggest focus area for differentiation in the market today. From a large PBM perspective, you can look at the Guided Health efforts at Prime Therapeutics. From a payer software perspective, you can look at Active Health.

Some of the examples from yesterday were interesting data points that you’d never see without digging into both sets of data. For example:

  • 84% of patients using PPIs chronically had no clinical diagnosis to support that
  • 67% of patients taking CNS stimulants had no clinical diagnosis to support that
  • 31% of patients taking atypical antipsychotics had no glucose monitoring
  • 60% of patients taking a psychotropic drug didn’t have a clinical diagnosis
  • Of course, the challenge is not only to identify them but to engage the patient and the provider in the best course of treatment looking at cost, outcomes, and patient experience.

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    2 Responses to “Why Blending Rx and Dx Data Matters”

    1. Linking the two clearly provides a better picture AND the doctor can do a better job if he knows the patient is/isn’t taking the meds (assuming that fill a script actually means you take the meds).

      But what concerns me about your listed stats is whether you’ve included “off label use” accurately. It is well known that drugs have non-approved benefits/uses. Zantac, an ulcer med, was used for a variety of non-ulcer purposes because it was the best drug and solved medical needs (acid reflux, post-op acid vomiting/inhalation before anti-emetics, etc.). We know some meds work great on pain but aren’t approved for pain. If we just quote a blind stat it can have misleading indications.

    2. Refer back to your comments on the importance of the TPA, they have the ability to make this link.

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