A Real-Time Benefit Check Success Story: 2022 PBMI Annual National Conference

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A Real-Time Benefit Check Success Story: 2022 PBMI Annual National Conference

As seen on Managed Healthcare Executive.

Executives from Arrive Health and OptumRx say they have ironed out many of the problems with real-time benefit checks, which deliver out-of-pocket cost and prior authorization approval information at the time a prescription is being written.

The need for prior authorization and shock at the high out-of-pocket expense — those are experiences that people typically have after leaving a medical appointment and are at the pharmacy picking up their prescription. They cause frustration, delay, and often, people not taking medication as prescribed or never getting the prescription filled in the first place.

Real-time benefit check, which involves checking cost and coverage at the time of the prescription, is supposed to eliminate those experiences and bring them into the prescriber’s office as the prescription is being written. But the reality check on real-time benefit check is that actual adoption has been slow, despite the intuitive appeal from both prescribers and patients wanting to know about insurance coverage upfront.

“The information presented is still not trusted,” Abhi Sindhwani said today at the 2022 PBMI Annual National Conference in Orlando, Florida. “The information sometimes is inaccurate.”

Sindhwani, senior vice president, payer/PBM market growth for Arrive Health, a real-time benefits check company that used to be called RxRevu, and Lauren Hackenberg, Pharm.D., senior EHR engagement director for OptumRx, led a session on real-time benefit check at the PBMI meeting today that focused on Arrive Health and the work it has done with OptumRx. The two companies have been doing business with together since 2018.

Hackenberg presented a slide showing that Arrive Health’s real-time benefit check resulted in the avoidance of 5,000 prior authorization approval processes per month and 14,500 drug switches. Another slide she presented said that as an OptumRx partner, Arrive Health handles 2 million unique prescribing events per month and that its services extend to a million people covered by OptumRx.

Sindhwani said PBMs, not just providers, have been wary of real-time benefit check technology because they haven’t gotten the information they want from the vendors and the systems they are selling. “There are unknown transaction volumes. What are the member savings? How many switches are happening? Which providers are more compliant than others?” Sindhwani said. “These are all question marks. These insights are not being provided (to PBMs).”

Both Hackenberg and Sindhwani talked up Arrive Health as fixing the problems that have bedeviled real-time benefit checks. For example, Sindhwani said there is an “intelligence layer” to Arrive Health’s software that can use national drug codes, the unique identifiers assigned to medications by the FDA, to locate pharmacies where a prescription is available and then the related insurance coverage. The Arrive Health software also curates messaging for the providers to make sure it is clear and accurate.

Real-time benefit tends to focus on patient costs. But Hackenberg and Sindhwani said it also is capable of calculating the cost to the payer.

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