Is Real Price Transparency Possible?
When speaking with health system clinical, pharmacy, and IT leaders, the first question we typically ask is: what is your price transparency strategy? The response we get most often is usually: “we’re already doing that with another vendor.” The problem with that response is twofold. First, many price transparency tools are deployed that display incomplete or inaccurate data. And second, a good price transparency strategy doesn’t end with an EHR-embedded tool, as often assumed.
Prescription price transparency is typically the first step in a broader price transparency strategy, since PBMs who manage formulary and benefit information have allowed vendors to access their data and deliver it to EHR systems. New regulations also mandate interoperability and openness of prescription data for large portions of the population. Bringing prescription information to the point-of-care – where decisions about medication orders take place – is possible with direct connections to payers and PBMs. But even with these connections, most health system leaders do not know how often they are displaying coverage information, and if that information is accurate.
The Problem with Current Prescription Price Transparency Strategies
When Real-Time Prescription Benefit (RTPB) solutions were first developed, interoperability was in its infancy, and the information being sent from PBMs to EHRs was lackluster – typically only including static formulary and benefit files. This type of data transfer is still common however, and many health systems think they’ve done enough by turning on RTPB through previously-installed vendors who leverage these antiquated methods. Using these obsolete tools can create unnecessary headaches for patients and providers since they may display outdated prices that are not equal to the price a patient will pay at the pharmacy. Since formulary and coverage details change constantly, tools that estimate patient prices are not sufficient for daily use and cause downstream work like pharmacy callbacks. Mis-quoted prices can also increase non-adherence, and research has shown that even slight increases in medication costs can increase the likelihood of prescription abandonment (AJMC, CDC).
Just as important as the data’s accuracy is the breadth of the data available. No RTPB vendor has data on every patient, so it is necessary to turn on multiple RTPB data streams to create the best patient and provider experience. Even vendors who claim to have ‘all-payer’ solutions are typically estimating medication prices, since not all PBMs have allowed access to their patient data yet. Having only one RTPB vendor leads to gaps in data and reliance on one data-feed to supply complete coverage – which does not exist in today’s fragmented market.
Building a Successful Price Transparency Strategy
First and foremost, having access to vast, accurate data is essential in creating a successful price transparency strategy. Instead of aggregating historic data from PBMs, best-in-class RTPB vendors have built direct connections to transmit patient-specific information in real-time – taking into consideration patient copays and deductibles to display the actual price a patient will pay at the pharmacy. RxRevu, a leading provider of prescription decision support solutions, offers such connectivity. However, even we do not have coverage data on every single American, and in many cases, our solution is turned on alongside other RTPB vendor offerings. This creates a seamless experience for providers and their patients, and reduces reliance on previously integrated, non-RTPB specific tools.
Beyond the data itself, teams must also have access to comprehensive reporting and analytics to understand prescribing patterns and opportunities. By looking at medication selections and switches (to other drug, location, or quantity options), care teams can better optimize prescribing behaviors and improve formulary adherence, decrease pharmacy callbacks, and reduce patient costs. In this way, insights-driven reporting can create a culture of ideal prescribing and positive behavior change.
It is true that most RTPB vendors provide basic price transparency capabilities. But RxRevu provides the industry’s most accurate, real-time price transparency solution, bringing patient-specific data to the point-of-care for millions of Americans. Our team supplements this capability with robust analytics to help teams understand system-wide prescribing variability, and drive best-practice behaviors to create a seamless patient and provider experience. It is the combination of these tactics that will make your price transparency strategy a successful one.
To learn more about how RxRevu can help develop your price transparency strategy, reach out today.
