Prescriber Tool Alternative Payment Model
Program Overview
The Prescriber Tool Alternative Payment Model (APM) is an upside-risk-only program designed to incentivize increased and consistent use of the Prescriber Tool, specifically the Real-Time Benefits Inquiry (RTBI) module, and prescription of preferred medications where clinically appropriate.
Program Year 1
The APM launched with Program Year 1 (PY1) on October 2nd, 2023. To earn payment, eligible practices were required to access their Prescriber Tool Dashboard, complete a brief RTBI training and attestation, and submit a Data Quality Validation and Feedback Survey by April 19th, 2024. 855 practices successfully completed the required activities to earn a shared savings payment, which the Department distributed on June 19th, 2024. In PY1, the Department was authorized to share 100% of savings with practices and distributed $1.15 million in total.
Program Year 2
Program Year 2 (PY2) began on October 1st, 2024, with the announcement of stakeholder engagement webinars which took place on October 28th and 29th, 2024. A recording can be found on this page under “Past Webinars.”
The savings generated by the tool in Fiscal Year 2024 is currently being calculated by the Department. This pool will be finalized in early 2025, pending approval. For PY2, the Department is authorized to share 75% of the total savings pool. In June 2025, the pool will be split and distributed to practices who have earned eligibility. Because the number of practices who earn eligibility is unknown until the activity window closes, the Department is unable to share how much payment amounts will be until they are ready to be distributed.
The activity window for PY2 will begin in January 2025, when the Department’s vendor Myers and Stauffer, LC will distribute information and a link to a feedback survey via email. The feedback survey must be completed by close of business on April 30th, 2025. Late submissions will not be accepted.
Who is eligible to participate?
The Prescriber Tool APM is open to Health First Colorado providers receiving fee-for-service payments for their outpatient pharmaceutical claims. The APM does not have a minimum attributed member size limit. Practices are automatically enrolled in the Prescriber Tool APM if relevant claims are attributed to the practice for the program year. Prescriber claims are attributed to the following eligible provider types:
PDF Document with Eligible NPIs and Names
For program year 2, the Department has attributed claims from Fiscal Year 2024 to eligible practices by NPI. The following document contains the name and NPI of the 6,219 practices eligible:
Excel Document with Eligible NPIs and Names
Past Webinars
The Department hosted informational sessions about the Prescriber Tool APM design for Program Year 2 in October 2024
Program Year 2
Prescriber Tool APM Dashboards
To support providers in this model, dashboards were created for providers participating in Program Year 1. These dashboards were brought offline at the end of the program year in June 2024.
Dashboards will not be generated or operated for Program Year 2. The Department is working to improve dashboard functionality to address feedback from Program Year 1 and aims to reimplement them in future program years.
Program Resources
- Prescriber Tool Webpage
- Reducing Prescription Drug Costs in Colorado Report
- Real-Time Benefits Inquiry Training
- Prescriber Tool APM Program Overview
Contact Information
Email hcpf_pharmacyapm@state.co.us for more information about the program.