Select a Patient's Payor

The payor (insurance carrier) that is selected for the patient affects formulary guidance (traffic light indicators), copay indicators, coverage restrictions, and alternates. In most cases, the LMR automatically selects the patient's insurance carrier in the payor field in the banner of the Medications screen. However, there are times when you may want to manually update this field:

Note: Before updating the payor field, check the "As of date" below the field in the banner. If the date is more than one day old, click Refresh (this button will not be active if less than 24 hours old). If you do not have an NPI number, you are prompted to select the provider that you are requesting data for. Click a provider name and Ok (ALT+O).

• If the patient has multiple payors. If so, clicking between payors can help you determine the best plan for the patient for each medication. Note that the traffic light indicators are updated when you do so.

• If "Unknown" is listed in the payor field. In may cases, clicking Refresh updates this field. However, patients with MassHealth and Harvard Pilgrim will continue to indicate "Unknown" in this field. These payors are not currently integrated with RxHub and the LMR.

Based on the patient's payor, you can view:

• Patient Cost

  Copay details can be viewed by clicking the traffic light indicators to the left of a medication name in the Medication List. They can also be viewed by clicking the Retail Copay link when performing a medication lookup, or in the banner of the Rx pad. For additional information, click here.

• Coverage Restrictions (including Prior Authorizations

  Coverage restrictions can be viewed by clicking the traffic light indicators to the left of a medication name in the Medication List. They can also be viewed by clicking the Retail Copay link when performing a medication lookup, or in the banner of the Rx pad. For additional information, click here.

• Medication Alternatives

Note: If no payor is identified, Partners' recommendations and alternative medications will still be available for your use.