Why FDB Sees Room for Competition in E-Prescribing Market

E-prescribing has been hailed as an industry success in terms of health IT adoption. In 2020, the Surescripts network’s adoption exceeded 1 million prescribers ordering a total of 1.91 billion electronic prescriptions, and it has continued to grow since then. But is there room for competition in the e-prescribing market? In a recent interview with Healthcare Innovation, Lathe Bigler of First Databank (FDB) explained why his company thinks the answer is yes.

This year, FDB has launched its own network called FDB Vela (pronounced Vee-la), which it describes as “a cloud-native electronic prescribing network that enables the seamless flow of critical medication prescription information, benefits verification, and clinical decision support between prescribers, payers, pharmacies, and other constituents.”

Bigler, the vice president of clinical network services and general manager of FDB Vela, came to FDB after working at companies such as Change Healthcare, Emdeon, Midmark Corp., and DrFirst.

First Databank is known for its well-adopted drug database, and Bigler noted that through this work, FDB already engages all the stakeholders in the e-prescribing process. “We work with almost all of the EHR systems, pharmacy benefit managers, payers, pharmacy retailers and pharmacy systems, so we're already very much involved and engaged in that process from a drug database perspective,” he said. “What's interesting is that as we began to engage with those customers and stakeholders around how we at FDB can provide more value to them, they actually brought up e-prescribing as a topic on several occasions. In fact, it became such a widely discussed topic that at some point we finally had to just look at whether this is something that we really should be offering to bring more value and more competition and alternative services in that space.”

I asked Bigler what type of issues these customers were mentioning and what types of opportunities FDB had identified. “A lot of it generally was just the lack of options and the lack of innovation. You know, e-prescribing has been around for 20 years. It is widely adopted. You give credit where credit is due in getting the industry where it is today in terms of adoption between other networks as well as CMS requirements,” he said. “But e-prescribing hasn't fundamentally changed in terms of the value that it may bring to certain stakeholders, be it providers, be at pharmacies, be it patients and consumers. So we see an opportunity to really enter the space by bringing more innovation to market.”

The FDB Vela website mentions “decreasing friction” in the process. Bigler elaborated that there are friction points in several areas.

“One starts at the beginning, which is simply implementing,” he explained. “We've talked to EHR system vendors who are wanting to participate in e-prescribing. It takes them six, nine to 12 months to just get implemented and to be able to offer those services to their providers. That was one of the first things we did is focus on driving automation around implementation certification with partners, whether it's PBMs, EHRs, or pharmacies. Another area is around specialty prescriptions. There's a great deal of friction in getting a patient prescribed a specialty drug, and this is really critical because a lot of these specialty drugs are very important to a patient's therapy and to their health. On average, what we're gathering is that the regular specialty prescription could take up to 24 days to be filled because of the friction and the red tape, so we're really focused on driving automation innovation in terms of APIs and leveraging AI technology to be able to bring that down to much less than 24 days.”

Bigler also suggested that FDB could bring innovation in terms of more advanced functionalities like better analytics and clinical decision support. “One of our core competencies is around decision support, not only from a drug database perspective. I think there are a lot of different ways we are willing to work with EHRs to improve their workflow process and how they inject information that brings better workflow and streamlines decision-making.”

In beginning to build an e-prescribing network from scratch, where do you start?  “A  network is only as strong as its weakest point, right? Our focus is really on all ends,” Bigler said. “We have to be ambidextrous, if you will, in terms of fostering our relationships with the EHR systems, with the pharmacy systems and the PBMs. We are actively engaged with all those points. We just launched in March 2022, but our focus in on growth in 2023.”

An FDB press release mentions that a vendor called Parker Health is the first publicly named partner. “Parker was the first that wanted to do a press release,” Bigler said, “and I think there is an interesting dynamic there because not all of our partners want to make press releases, which I understand. There are some sensitive issues on their ends that we're very cognizant of, and we want them to be very comfortable.”

Parker Health, he added, is a fairly new EHR system. “However, they have a lot of very innovative technology components, as well as a mindset that we really appreciate and are excited to work with. They were really focused on getting implemented right away, and that's one thing they can't do through other networks. They're trying to get to market and bring value to their customers, and they're trying to include new workflows that we’re willing to work with them on.”

I asked Bigler what we should watch for from FDB Vela in 2023.

“I think you'll see a few announcements with top five EHR systems, working with our Vela platform, and we'll also see some very large pharmacy systems and large PBMs participating,” he replied. “We're very excited about what we have lined up. One more thing I'll add is that we announced earlier this year that we are the first veterinarian e-prescribing network in the industry. What we're focused on is enabling the veterinarian community to participate in e-prescribing so that they can access retail pharmacies as well and start to manage their prescriptions better for their pet patients, which really improves the workflow experience.”