Nearly half of transactions for prescription drugs include an option for patients to receive their medication at no out-of-pocket cost, according to a recent analysis by healthcare technology company Arrive Health using its Real-Time Prescription Benefit (RTPB) tool.
“We’ve built a network that is directly connected with the major pharmacy benefit managers on one side and the major electronic health records on the other,” said Christie Callahan, the chief operating officer for Arrive Health. “The goal is, at the point a provider is writing a prescription, to get them an answer in real time about how much that prescription is going to cost and whether or not there are opportunities to optimize how much that patient will have to pay out-of-pocket based on their insurance.”
Arrive Health reviewed a total of 78.26 million RTPB transactions involving more than 300,000 providers completed between electronic health record (EHR) prescribing workflows and pharmacy benefit manager (PBM) databases from its nationwide network in 2022. The company identified 36.6 million transactions (46.78%) in which a $0 option was available for the pended medication (medication orders put into the EHR ordering workflow prior to being sent to the pharmacy). This more affordable option could be an alternative drug, a different formulation (such as a patch vs. a tablet), use of mail order delivery instead of picking up the medication from a retail pharmacy, or multiple doses instead of single refills.
In 10.6% of cases, the Arrive Health RTPB solution found an alternative that would cost the patient $0 when the originally pended medication would have cost more.
Certain medication classes had more frequent opportunities to reduce patient costs. HMG-CoA reductase inhibitors (statins) for the control of cholesterol levels were pended 2.83 million times; 28.18% of the time, the pended medication had an associated cost, but the Arrive Health solution showed an alternative statin that would cost the patient $0. Long-acting and rapid-acting insulins, which were pended 417,000 and 224,000 times, respectively, both had $0 options available 47% of the time.
“It was very compelling to see that in so many critical classes of medications for chronic disease states, many people had access to $0 medications, especially in a world where we continue to hear about high-deductible plans and the first-dollar cost burden being placed on patients,” Ms. Callahan said. “This highlights the nuances of how hard it is to figure out the right answers here. Those $0 cost options are not always straightforward. But there is a tremendous opportunity for patients when done correctly.”
As an example, she cited a patient in North Carolina whose provider had prescribed an inhaler for asthma and used the patient’s preferred retail pharmacy as a default. “The cost of that medication was going to be $447.95,” Ms. Callahan said. “But because of the chronic nature of the condition, the patient’s plan had full coverage for the same inhaler if the provider prescribed three inhalers through the mail-order pharmacy. So they went from effectively $1,500 to $0 for three inhalers, without even a medication change.”
The tool also demonstrates the role pharmacists can play in improving patient adherence and outcomes by driving awareness of potential cheaper alternatives whenever cost is a factor, said Ryan Frickel, PharmD, Arrive Health’s senior product manager. “Most pharmacists today don’t have access to real-time prescription benefit data. Ideally, that will change at some point in the future so pharmacists can counsel patients of lower cost alternatives using information right in front of them,” he said. “In the meantime, pharmacists can use this analysis to understand when to inform patients there may be a cheaper option available.”
For example, the analysis revealed that statin drugs had a $0 option 64.7% of the time, whether that was the originally requested medication or an alternative. “So, if you’re in the pharmacy and most of your insured patients have a copay for their statin, that doesn’t correlate with the data we see,” he said.
Pharmacists may also be able to notify patients of potential savings for contraceptives, which had $0 options 85.5% to 98.1% of the time depending on the formulation. “So, if most of your patients on contraceptives are paying copays, something’s wrong,” Dr. Frickel said. “Always assume that it’s all right to ask the patient if they are aware that there could be cheaper alternatives.”
This article originally appeared on Pharmacy Technology Report.
