How PBMs Use Direct Messaging to Improve Care Coordination and Reduce Costs

As a pharmacy benefit manager (PBM), there are a lot of touch points in your business. Whether you’re communicating with pharmacies, healthcare providers, or patients, it’s essential to find every opportunity to improve efficiency and outcomes. Thanks to advancements in the secure exchange of health information through easy, patient- and provider-friendly direct secure messaging, you can!

And because 95% of hospitals and 87% of doctors are now using a certified electronic health record (EHR) system, a PBM’s ability to drive efficiency and capitalize on direct messaging has become easier than ever.



In a recent webinar, iShare Medical founder and CEO, Linda Van Horn, detailed the features, benefits, and value direct messaging provides PBMs.

Before You Can Be Efficient, You Must Be Trusted

Because the Health Insurance Portability and Accountability Act (HIPPA) imposes penalties on providers and payers who wrongfully share information, trust and verification of identity for the sharing of medical health information is critical.



Before sharing information, you need to know with whom you’re communicating. Then you need a way to safely and securely share this information. There are three things that are important to know:

1. Authentication (proof of the identity)
2. Authorization (proof that they have a valid origination and destination endpoint)
3. Sharing (secure encrypted exchange among trusted endpoints)

Learn more about the 3 things you need to know to safely and securely share medical information.

Why PBMs Are Using Direct Messaging

A Direct message can deliver information directly into the provider inside of their EHR workflow and contain any electronic payload (including C-CDA, HL7 V2.5 ADT, FHIR, Word, Excel, video, photos, audio). Incredibly flexible, direct messaging offers a variety of benefits to PBMs.

Improves communication. Allows you to have bi-directional exchange with the provider right into their EHR. If you've ever wondered as a PBM, “What’s the most efficient way to reach the doctor and prescribing provider?”… this is your answer.

Reduces cost and time. By automating daily tasks that were once manual and laborious, PBMs can save significant time and money.

Expedites response times. PBMs can get to the prescribing provider inside of their EHR and enter the work queue. Most doctors review lab results and complete prescription requests before leaving their practice at the end of each day. This means that in many cases the provider will process your request for changes to prescription orders or clarifications get handled the same day it is received.

Improves accuracy. Data is sent electronically from the source such as the EHR, payer system, or patient.

Mitigates risk. Via secure encryption among known secure trusted endpoints because the sender and receiver have been ID-proofed and their identity is always known.

Direct Messaging Use Case Examples for PBMs

1. Obtain prior authorization for medications
2. Interact directly with the doctor or other prescribing practitioners regarding drug formulary and generic alternatives
3. Inform providers about drug formularies that don’t require prior authorization—helping to reduce the prescriber’s burden 

1. Notifying the prescribing provider when two or more providers are prescribing the same or similar medications to the same patient for the same problem
2. Understand if the quantity being filled is consistent with the patient’s medication order so you can know if the patient is taking the medication as directed

Medication Safety

1. Accurately match the medication to the genome of the patient through drug to drug, drug to allergy, and drug to genetics
2. Communicate medication safety concerns regarding dose and quantity
3. Mitigate opioid risk factors when schedule II medications are being prescribed by two or more providers which could indicate that the patient is diverting or abusing opioids

Medication Adherence

1. Notify provider that patient’s refill frequency is out of compliance with Rx
2. Set up automatic refills for medications and supplies
3. Communicate discounts to patients

Specialty Pharmacy

1. Educate provider and prescriber about generic alternatives
2. Send instructions or videos to patients about how to properly take their medication
3. Send medication reminders to patients

Further Your Exploration on Direct Messaging

This article provided a recap of the recent webinar, 5 Innovative Ways PBMs are Using Direct Messaging to Improve Care Coordination and Reduce Costs.

>>Request the PBM direct messaging webinar here.

To dig deeper, check out the full list of use cases for direct messaging for PBMs, and see how you can increase efficiency and streamline operations for your team.