Every day, payers and PBMs are looking for ways to drive value and improve care quality, while reducing costs. Real-Time Prescription Benefit (RTPB) can bring member-specific data to the point of care, helping providers make informed, low-cost medication decisions.
Regulation from CMS mandates that plans covering Medicare Part D lives create networks to allow for the transfer of prescription coverage data. Many industry experts think that rules for commercial plans are soon to follow — making requirements for transparency even more widespread.
But why take the time to turn on a Real-Time Prescription Benefit data feed? Below, we’ve outlined some of the benefits of superior RTPB technologies and how payers and PBMs can quantify its value:
- First, setting up a RTPB data feed can reduce administrative burden for payer and PBM teams. RTPB solutions can reduce prior authorization usage (by supporting providers in selecting formulary-driven options), alleviating time spent on clearance requests and processes. Additionally, instead of spending time on formulary communication and awareness, RTPB can automatically alert providers of covered medications and alternatives in real-time; again, freeing up time that could be spent on other priorities.
- Secondly, RTPB receives information from source-of-truth databases, making it possible to drive ideal prescribing behaviors that benefit both the member and PBM. For example, RTPB can increase on-formulary, mail-order, or generic prescribing. As a physician selects a medication, RTPB can alert them of clinically-viable, lower-cost alternatives that are covered under the member’s pharmacy benefit. Further, best-in-class RTPB solutions can also display various fulfillment options in the workflow, allowing providers to see costs for retail and mail-order options — depending on which are preferred by the member or plan design.
- Lastly — and most importantly — RTPB can improve member health and experience. Members are becoming healthcare consumers, often shopping for their care. They have become more cost-conscious and health plans that allow price transparency support are often selected over those who do not. Creating an environment where physicians can have affordability conversations drives member satisfaction, and provides a sense of empowerment to members. Point-of-care price transparency also reduces stick-shock when members reach the pharmacy, and can lower the overall cost of care when covered alternatives are available. RTPB has the ability to drive medication adherence for members as well, since lower-cost options are always preferred by members.
Setting up a RTPB connection is an easy way to deliver member-specific data to provider workflows, where decisions about prescriptions take place. Reducing administrative burden, driving ideal prescribing behavior, and improving member health and satisfaction are only some of the benefits that payers and PBMs can realize by turning on this service.
If you are interested in learning more or want to explore how Arrive Health can help you deliver relevant content to the point of care, please reach out today.