Prescriber Tool Alternative Payment Model Overview
The Prescriber Tool is a prescription benefit tool to improve prescription drug transparency and affordability, improve member access, and decrease the administrative burden for providers. The Prescriber Tool has four modules: electronic prescribing (eRx); electronic prior authorization (ePA); opioid misuse risk module (Opisafe); and real-time benefits inquiry (RTBI).
The Prescriber Tool APM has been designed to support the uptake of the Prescriber Tool and to ensure it meets the needs of providers and members. It is scheduled to be launched in fall 2023. More details about program launch activities will be published when available.
Prescriber Tool APM Design
The Prescriber Tool Alternative Payment Model is intended to increase awareness of the RTBI module function as well as corresponding reporting that the Department receives on use of the module. Additionally, it is designed to provide information on the Prescriber Tool capabilities as well as solicit feedback to ensure that the Tool evolves in a way that meets provider needs.
Feedback from a pilot period from March to April prompted the Department to adjust the program design to better meet the current landscape and program goal. While the Department works to incorporate this feedback, providers are encouraged to visit the Provider Web Portal to ensure their enrollment is up to date as this can influence performance in the program.
Prescriber Tool APM Performance Dashboards
To support providers in this model, dashboards will be created for eligible practices. The Department conducted a pilot of the dashboards to test their functionality from March to April 2023. Resources about this pilot period are below:
Development History
Design for the APM began in late 2021 and has been iterative to reflect the needs of providers. This included adding a year to program development to allow for time to assess functionality of the RTBI module among different EHRs around the state.
Last year, the Department hosted two sessions for stakeholder engagement around the Prescriber Tool APM design. This was to present the proposed final model design prior to a small pilot of dashboards that related to the program design. The slides and meeting recordings are linked below. Please note that the slides linked below in this section do not reflect the most current design
Nov 16, 2022 2:00-3:00 PM Mountain Time (US and Canada)
Prescriber Tool Alternative Payment Model (APM) Design Feedback Session #1
Nov 17, 2022 7:30-8:30 AM Mountain Time (US and Canada)
Prescriber Tool Alternative Payment Model (APM) Design Feedback Session #2
Who is eligible to participate?
This APM is open to providers receiving fee-for-service payments for their outpatient pharmaceutical claims, paid by Health First Colorado. This APM does not have a minimum attributed member size limit.
Program Resources
Contact Information
Email hcpf_pharmacyapm@state.co.us for more information about the program.