Due to both federal regulations and consumer demand, there’s been an increasing push toward price transparency in healthcare. Real-Time Prescription Benefit (RTPB) solutions are helping, giving providers and patients visibility into medication costs. When leveraged, these tools improve affordability and adherence – even finding $0 medication options nearly half the time.
Unfortunately, not all RTPB solutions are created equal and organizations relying solely on legacy solutions, eligibility, and Formulary and Benefit files, are preventing these tools from reaching full value for providers and patients – like saving one patient $279 by switching the pharmacy pick-up location or helping a pulmonary department avoid 31% of unnecessary PAs.
If it’s been a while since you added your RTPB connection, or if you’re wondering what new capabilities exist to help your organization get more value from your RTPB service, now is a good time to revisit your strategy and consider adding another connection.
We asked price transparency experts to weigh in on the topic, and here are four signs indicating you need an RTPB checkup:
- Providers are reporting missing or inaccurate results. Different RTPB vendors have different relationships. Adding more than one RTPB connection can fill network coverage gaps, resulting in more accurate, actionable data being displayed in provider workflows. For example, some Blue Cross Blue Shield plans may not be supported through legacy solutions, so having more than one RTPB connection can ensure those members are covered.
- Providers say the information returned isn’t helpful. EHRs and PBMs speak different languages and that is a continual and evolving challenge. Intelligent RTPB tools work behind the scenes to normalize data, filter out erroneous results, and simplify messaging so providers see the most relevant information in every patient encounter. As a result, they drive more value out of each provider encounter and increase trust and engagement with the tool.
- The prior authorization process, when needed, still takes days to complete. A high-quality RTPB connection can identify on-formulary medications and help providers avoid unnecessary PAs. But when PAs are truly necessary, enhanced RTPB solutions can auto-trigger the ePA process before the patient arrives at the pharmacy counter – saving staff members from burdensome faxes and phone calls.
- Patients are asking providers for help when RTPB coverage doesn’t exist. About 50% of RTPB calls don’t return pricing data due to lack of insurance or uncovered medications. Instead of asking providers to be a personal shopper and scour websites for alternative options, RTPB vendors with the right networks can complete a comprehensive scan of affordability options and send the best option directly to patients for easy use.
Real-time prescription benefit tools have come a long way and organizations are primed to realize more cost and time savings with enhanced offerings.
Learn how your current RTPB solution checks out and what new capabilities are available to address the pain points described above. Contact Arrive Health for an RTPB checkup today.