Photon recently partnered with Arrive Health to provide real-time benefit checks in our provider flow. We’ll run a coverage check for all draft prescriptions for participating organizations.

The results are based on the patient’s benefit, pharmacy, and treatment. Coverages will come back with one of three statuses:

• Covered - this status will display a co-pay amount
• Covered with Restrictions
• Not Covered

Often, a coverage check will show “Other Options”. These might be therapeutic alternatives or different pharmacies. By clicking “Select This Option”, the original will be removed, and the form pre-populated with that option’s values. The selected Pharmacy will also be updated, if different for that option.

Creating Patient Benefits

In order to generate a coverage check the patient will need to have a benefit associated with them. You can do this by running a similar mutation:

(Give it a shot in our sandbox)

mutation CreateBenefit($input: BenefitInput!) {
  createBenefit(input: $input) {
    id
    groupId
    memberId
    payerId
    pcn
  }
}

input BenefitInput {
  patientId: ID!
  bin: String!
  memberId: String!
  pcn: String
  groupId: String
}

You can verify the patient’s benefit by querying for it on the Patient object:

query Patients($filter: PatientsFilter!) {
  patients(filter: $filter) {
    benefits {
      id
    }
  }
}

Configuring Photon Elements

In order to display the coverage checks, make sure your version of Elements is v0.16.0. Enable the feature by setting the enable-coverage-check to true:

<photon-prescribe-workflow
  enable-coverage-check="true"
  ...
></photon-prescribe-workflow>