As providers tackle new challenges that have arisen because of the COVID-19 pandemic, they are often still facing underlying annoyances while delivering care. While telehealth has become the new norm, doctors must diagnose and treat patients from afar without damaging the overall patient experience. And with more nuanced data available and additional steps necessary for reimbursement, care teams are looking for ways to reduce friction wherever possible.
Prescription Friction for Providers and Their Care Teams
Throughout the prescribing process, there are instances where providers are met with and frustrated by technical hurdles, lack of patient-specific data, and time-wasting tasks. In the typical prescribing workflow, providers enter their EHR and are immediately met with friction when starting a medication order. How do they know which medications are covered under the patient’s insurance plan? In many cases, patient coverage information is not available at the point-of-care, and if it is, it may not be embedded seamlessly into the EHR workflow. Providers may need to search for medication class information or formulary details outside of the EHR, or ask patients questions that they likely cannot answer. Further, coverage and cost data within the EHR is often not trusted by providers since it can be estimated or historic data pulled from a patient’s PBM at an unknown interval. Between the lack of accurate patient data, inconsistent methods used to find covered medications, and non-helpful information overload – it is no wonder upwards of 64% of providers feel as though the EHR is a primary source of daily frustration (AAFP, 2019).
In addition to the aforementioned friction points that are present within the EHR, after a prescription has been ordered, there are often additional steps needed to get that medication into the patient’s hands. In many cases, prior authorization (PA) is required and a patient won’t receive their medication until the PA is cleared. It is usually up to the provider and their care team to call the patient’s health plan, coordinate with the pharmacy, and ultimately encourage the patient to pick up the medication. In some cases, teams need to re-order or update a medication order, just so it can be completed and sent to the pharmacy. Research from the American Medical Association outlines some of the negative impacts of PA on provider workflow and patient health. They report that 64% of surveyed care teams waited at least one business day for a PA response, 91% reported care delays associated with the PA process, and on average, teams spent 14.4 hours each week completing PAs. What’s even more worrisome is that 74% of the providers surveyed reported that PAs always, often, or sometimes led to treatment abandonment (AHA, 2020)! Providers and their teams have unfortunately become accustomed to a burdensome prescribing process and the work associated with getting patients their medications.
Friction for Patients Exacerbates Non-Adherence
The points of friction providers face are worsened when patients are looking for answers at the point-of-care. In a recent survey, 62% of patients said that knowing their estimated out-of-pocket cost influences whether or not they will access healthcare (PatientEngagementHIT, 2019). To put it simply, not knowing the cost of prescribed medications can drive medication non-adherence. And if the cost of the prescribed medications is too high, patients may request less-expensive options, leading to a flurry of calls between the pharmacy, insurance carrier, and doctor to find a new medication option. The American Journal of Managed Care reported that an increase of $10 in copay can boost the likelihood of prescription abandonment by 10% (AJMC, 2006), highlighting how price-sensitive patients truly are.
Patients also meet friction when deciding how to receive their prescriptions. They often ask: “should I get this medication delivered to my home, or should I pick it up at the store?” There is often a lack of data provided to them about what a medication might cost via different fulfillment options. Patients should be able to trust that they have been prescribed the most cost-effective medication option at the most convenient location, but in most cases, they are not given any medication-specific information until they reach their pharmacy. Displaying and communicating accurate pricing and fulfillment information earlier in the care journey is often the difference between patients picking up their medications, or abandoning them altogether.
Real-Time Prescription Benefit (RTPB) Technology and Alleviating Prescription Friction
In many cases, providers prescribe medications they are familiar with and follow the path of least resistance when completing a prescription order. However, new tools are allowing providers to access formulary-driven information on medication alternatives, know which drugs might require PA, and view the cost of each option – all within the EHR. This technology – commonly known as Real-Time Prescription Benefit – is becoming readily available for care teams, and is eliminating many of the friction points throughout the prescribing process.
First, providers no longer need to search – inside or outside of the EHR – for insurance or coverage information on each patient. RTPB connections bring formulary data to the provider’s fingertips so they can view medications that are covered under the patient’s plan, as well as restrictions associated with their order. Instead of making the PA process simpler or faster, RTPB can help care teams avoid PAs altogether by displaying flags on restricted medications, and recommending medications that fall in the same drug class but do not require PA. Further, if lower-cost alternatives are available, RTPB can present those options for selection. There are no new systems to learn or websites to access. All of the patient coverage information is shown directly in the EHR when placing the medication order, and selections can be switched with just one click.
Next, providers can be confident that patient data is accurate and specific (when using RxRevu’s RTPB tool), since it is being pulled in real-time through direct connections to the nation’s largest PBMs. RxRevu has worked tirelessly to build transaction pipelines that transmit data on more than 120 million patients across the country. This data takes into consideration patient copays and deductibles, and helps display the actual price a patient will pay at the pharmacy. If coverage information isn’t available for a specific patient, we are able to display GoodRx pricing to maintain a consistent and positive experience for both the patient and provider.
Lastly, with RTPB tools in place, the patient experience can be transformed to a seamless and straightforward one. Providers are able to inform patients of their medication cost responsibility upfront (and discuss lower-cost options), recommend fulfillment options that are more convenient, and help eliminate prior authorization or restrictions that might arise at the pharmacy. Patients no longer need to guess what they might owe, or delay care because of ambiguous coverage policies. Instead, they can pick up their medication at the right price, at the right location, at the right time.
With friction in the care journey continuing to be a hindrance, teams are looking for ways to streamline processes and ease burdensome tasks. Fortunately, RxRevu is bringing accurate data to the prescribing workflow to allow for a frictionless medication ordering experience. To learn more about how RxRevu’s RTPB solution can be turned on within your EHR, please contact us today.