Healthcare API platform startup PokitDok has unveiled a new suite of pharmacy APIs to bring quick data access prior to writing prescriptions and sending patients to pick them up. Starting today, physicians, EMRs and other digital innovators can have a consolidated view of patient prescription plans, qualified formularies, in-network pharmacies, and related financial information.
Lack of Real-Time Integration
While hospitals and medical practices maintain EHRs to house patient health history, the prescription benefits process may not be optimally integrated. Electronic prescribing relies on technology developed more than a decade ago, which still requires batch file transfers of volumes of data. This lack of real-time integration induces an inefficient review process and is difficult to navigate. As a result, in many cases, eligibility, coverage and cost is not considered before writing a prescription.
Pharmacy Suite API Benefits
PokitDok makes a library of drug information, formularies, Medicare Part D pharmacy network and pricing information available through an API that draws data from the Centers for Medicare & Medicaid Services (CMS) and First DataBank. The API’s real-time digital access helps provides insight into which medications are covered by a member’s insurance plan before prescribing, ensures those drugs are available for pick up from a qualified pharmacy, and subsequent payment is processed accurately.
Additionally, the APIs can enhance a medical visit by enabling more informed treatment plans, whether it takes place at a hospital, private practice or through a telemedicine session from the comfort of home.
The new suite of pharmacy benefit and eligibility API tools include:
1. Pharmacy Plan API, which reveals a member’s pharmacy plan name, premium, deductible, initial coverage limit and copays for each tier – from lower cost generic drugs to patented medications. Plans can vary in their drug coverage and prices for the same drug are not always the same.
PokitDok makes information available from more than 16 million Medicare Advantage Beneficiaries and 40.5 million who rely on Medicare Part D Prescription Drug Benefit Plans. Private health insurance plans separate from Medicare are under development.
2. Pharmacy Formulary API provides a deep dive into the member’s pharmacy benefit, including what drugs a patient is eligible for and how much they can obtain at one time. It covers tier level, authorization and step therapy requirements, which require patients to try one drug before progressing to a drug that may introduce health risks or an additional expense, and quantity limits.
This API covers the economic components, including an estimated price and cost break down of who is paying what. It returns details about a medication’s out of pocket cost, total cost, and payment that insurance kicks in.
3. In-Network Pharmacy API geolocates retail pharmacies, identifies available mail order institutions and authenticates the dispensing pharmacy as being covered by insurance, giving patients an informed choice for prescription fulfillment.
The National Provider Identifier (NPI) is used to verify the prescribing party, such as a physician, nurse practitioner, physical therapist or dentist. PokitDok makes this information available from one of the largest provider directories on the market.
To date, more than 4000 applications have been built on PokitDok’s development platform. The new set of APIs are immediately available and developers can integrate them into existing health IT systems today.
Founded in 2011, PokItDok was born in response to founder Lisa Maki’s difficulties finding a non-surgical treatment for a spinal injury she discovered while studying karate. Some of PokItDok’s customers include Doctor on Demand, HealthiestYou, PracticeSense, Silversheet and others.