Physician Insights: What Happens When Accurate Prescription Benefit Data Is Missing


Physician Insights: What Happens When Accurate Prescription Benefit Data Is Missing

Providers want to help patients by prescribing affordable and accessible medications, but that is hard to do with low-quality RTPB data.

It’s no secret that patients are carrying more of their healthcare costs than ever before and that there is a correlation between a medication’s price and adherence. Providers want to help by prescribing medications that their patients can access and afford. But countless plan variations, frequent formulary changes, and patient-specific accumulators make it challenging for providers to understand what medications are covered and what their costs might be.

Real-Time Prescription Benefit (RTPB) technology is a proven way to help, giving providers access to real-time cost information directly within their existing workflows. Unfortunately, not all solutions are created equal and data provided from legacy RTPB solutions isn’t always helpful. 

What happens when real-time information isn’t available or reliable? 

We surveyed over 200 providers across the US to better understand the implications of low-quality RTPB data and what providers need to improve prescribing workflows. Our results show that there are quite a few answers to this question:  

  • Providers lean on historic prescribing habits. “I have go-to favorite medications,” said one primary care physician. “A lot of the time, I may be moved by samples that I have in the office and coupon vouchers.”
  • Providers miss out on coverage restriction alerts, and patients experience delays in care. “Sometimes the patient comes back and says insurance denied the prescription,” a physician explained. “So, I walk them through the fact that it’ll take a couple of weeks for insurance to approve it or not approve it. If insurance doesn’t approve it, we will come back and talk about what other options there are.”
  • Providers, care teams, and pharmacists must complete re-work. Over three-quarters (77%) of providers said they have had to change, manage, or resend a prescription order after it had been sent to the pharmacy. 
  • Cost is left out of the conversation. Only 27% of providers said they always discuss mediation prices with their patients, resulting in many patients being blindsided by medication costs and returning to their providers for alternative care plans. 

How should health systems respond?

The consequences of poor RTPB data – poor patient adherence, outcomes, experiences, and time spent on re-work for providers – are clear and should not be ignored. One way health systems can improve RTPB results is by adding additional RTPB connections through solutions, like the one Arrive Health offers. We have an entire team focused on RTPB data quality initiatives and we are dedicated to delivering meaningful results that providers can use with their patients.

If your providers are struggling with unreliable RTPB data from a legacy partner, we can help. Contact us to talk with a member of our team.

Curious to learn more about what else providers have to say? Download a copy of our full survey report, Physician Insights: What’s Needed to Improve Prescribing Workflows.

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