First Databank, or FDB), owned by Hearst Health, announced in March at HIMSS22 the launch of the country's second e‑prescribing network, FDB Vela.

For more than 15 years, the country has been served by only one e‑prescribing network, Surescripts, which this week appointed Frank Harvey as its new chief executive following the retirement of CEO Tom Skelton. 

FDB contends that having only one e‑prescribing network nationwide for an extended period of time has slowed innovation, limited pricing negotiation and stifled competition – to the point that the FTC has even filed a restraint of trade suit against Surescripts.

Healthcare IT News decided to check in on FDB Vela to learn more about the nation's second e‑prescribing network and learn about its progress since launching three months ago. We interviewed FDB President Bob Katter, who went in-depth on e‑prescribing.

Q. What made FDB decide to launch an e‑prescribing network?

A. As participants in the industry, we saw there were unmet needs and therefore an opportunity in electronic prescribing, particularly in terms of innovation. We had been contacted by several major clients, who inquired if we were considering launching an e‑prescribing network, given our knowledge of the prescribing and dispensing processes and our relationships with key industry players.

Before we decided to invest in building and launching the FDB Vela network, we met with major pharmacies, pharmacy benefit managers and electronic health record vendors to gauge their interest, which turned out to be quite high.

In general, it is never a good idea to have only one of anything in business, because it tends to lead to higher costs and lower innovation. We believed FDB was the ideal candidate to help usher in fresh ideas and improved efficiencies across the industry, since our drug knowledge solutions already touch all the major stakeholders in the e-prescribing ecosystem, including large PBMs, major pharmacies and a whole gamut of EHR vendors that equip the provider community with medication decision support tools.

To put it in basic terms, if you consider an e-prescribing network as a set of pipes through which information flows, FDB is not only knowledgeable about creating the infrastructure for these pipes, but also about the data flowing through them.

The information flowing through the pipes includes prescriptions, prior authorization requests, eligibility requests and patient medication history, and is largely based on FDB data. With this in mind, we realized that we could create an exciting new e-prescribing network option that would serve the stakeholders with whom we already work, enabling them to innovate and better serve their customers to improve outcomes for patients.

Q. How does your e-prescribing network work?

A. From a technology standpoint, we are a Microsoft Azure-certified partner, and our network infrastructure is built on top of Microsoft cloud server technology that is highly scalable and secure. Our network is also fully compliant with National Council of Prescription Drug Programs (NCPDP) transaction standards, so whether there is an eligibility request or a medication history request between a provider and a PBM, or a provider and a pharmacy, it follows all those standards.

We have even taken it a step further in some of the features we offer. For example, FDB Vela includes real-time pharmacy benefit checking that goes beyond the traditional NCPDP formulary check for medications, because it delivers real-time information to the prescriber about the patient's financial responsibility, so the prescriber can have a fully informed discussion with the patient.

Because, in some cases, particularly with newer specialty prescriptions, the patient will show up to the pharmacy and have a huge out-of-pocket cost, and they will turn around and leave the pharmacy without their important medication. They then have to call their doctor to discuss more affordable options. With real-time pharmacy benefit information, those discussions are moved upstream to avoid delays.

From an administrative standpoint, our network connects EHRs and providers with PBMs and other drug payers. Of course, pharmacies of all types can connect, whether those be traditional pharmacies, large retail or specialty pharmacies, online pharmacies, or even pharmaceutical services hubs.

FDB Vela is open to all entities that have a legitimate purpose to transact, even those that have been challenged to participate in e-prescribing in the past. Veterinarians, for example, who cannot today e‑prescribe pet medications, will be able to participate in FDB Vela through their veterinary practice information systems.

We also plan to work closely with startup technology vendors and others who have historically been shut out from participating in e-prescribing.

We have designed FDB Vela specifically to foster innovation in e-prescribing for all participants, many of whom have been challenged by numerous costly and time-consuming e-prescribing network requirements and have even abandoned new solutions due to resource limitations. We want to remove those barriers so they can introduce new technologies and approaches that help serve their customers and patients better.

Regardless of how or why participants access the FDB Vela network, our contract structure is extremely flexible, without binding requirements or exclusivity restrictions. FDB Vela participants can select the e-prescribing network that best meets their needs for each transaction type.

We are making connecting with the e-prescribing network quicker and easier through the use of advanced application programming interfaces. Integrating with FDB Vela is typically a two- or three-month process leveraging FDB Vela APIs. Participants can use their imaginations and configure their e-prescribing-related workflows to suit their requirements instead of ours.

We have streamlined back-end and front-end processes leveraging modern technology that has massively improved since e-prescribing was introduced two decades ago. It is faster, more flexible, more powerful and optimized for mobile application workflows.

The technology is able to process high volumes of transactions with greater reliability and accuracy. Built in the last two years, the FDB Vela network reflects the technological capabilities today, not those of previous decades.

Q. How does FDB see itself competing with the nation's only other e-prescribing network, Surescripts?

A. Ultimately, it comes down to offering choice and excellent service to our customers. Our customers, after all, are the ones telling us they want e-prescribing choice and came to us because we have been their source for drug knowledge for many years.

Beyond offering basic transaction services, we are looking to innovate in areas that have not been fully explored yet in e-prescribing. Prescribing specialty medications, for example, is still a highly manual, paper-driven process conducted via phone and fax, and it takes on average more than 20 days to complete, which leaves patients waiting for vital treatments.

FDB Vela brings specialty enrollment services directly into the clinician's ordering workflow, eliminating the current set of overlapping manual transactions. By automating enrollment and prescription routing for specialty drugs, we can save staff hours each week and dramatically reduce fulfillment wait times for patients.

That is just one example of how we are fostering innovation in e-prescribing. We are working in other areas as well and anticipate there will be even more opportunities in the future. That is why we are giving participants in the FDB Vela ecosystem the tools and flexibility they need to create services and customize e-prescribing workflows for their users.

The Microsoft Azure architecture with advanced API functionality, as I mentioned before, is part of that, but the FDB Vela business model is collaborative and empowers all participants to bring their own simple or aspirational ideas for e-prescribing to market without barriers. We strive to never say "no" to a customer who tells us, "We have this great idea for our solution that accesses FDB Vela."

On the contrary, we want to be easy to do business with and work closely with our customers to develop and make that idea a reality.

By supporting innovation through easy-to-integrate, highly scalable technology and flexible contracts, we believe FDB Vela will emerge as the preferred e-prescribing network. For more than 40 years, FDB has been the leader in the medication decision support industry with the most widely used integrated drug database in the United States.

We are trusted across the industry to support mission-critical prescription ordering, fulfillment and consumer education activities. We are confident that many of the stakeholders I have mentioned – including EHR vendors, PBMs and pharmacies – will be open to expanding their e-prescribing relationships to include FDB Vela, considering the enhanced value and freedom our new network affords.

Finally, participants in the FDB Vela network will benefit from FDB's neutrality. Our owner, Hearst, is one of the nation's largest and longest operating family-owned companies and is proud of its independent heritage.

FDB has strived for decades to uphold the highest standards of honesty, objectivity and transparency in publishing our industry-leading MedKnowledge database, free from inappropriate outside influence. Those standards and values extend to FDB Vela.

Q. Where does FDB plan to head in the future when it comes to e-prescribing?

A. There are many new opportunities within e-prescribing that we want to explore with our customers and with FDB Vela, starting with empowering the patient to manage their own prescriptions. We believe that patients should have access to more information about the cost of their prescriptions when conferring with their doctor and more flexibility on where they choose to fill their prescriptions.

We want the consumer to be able to access FDB Vela through a mobile app or website of their choice and query real-time pharmacy benefit information to determine their out-of-pocket expense at participating local and online pharmacies.

We want to reduce the incidents of prescription sticker shock and medication abandonment at the pharmacy. We believe this can help drive medication adherence leading to lower patient risks, better clinical outcomes and reduced healthcare system costs.

Twitter: @SiwickiHealthIT
Email the writer: bsiwicki@himss.org
Healthcare IT News is a HIMSS Media publication.