The other day, I was in my doctor’s office for a routine checkup and she asked about my work. When I explained that my company, RxRevu, provides a connection to bring real-time prescription benefit (RTPB) into the prescribing workflow, her response was similar to that of every doctor I’ve met across the last year.
“Do you mean that you can save me from memorizing which health plans cover what medications?” She continued, “every January, we start from scratch, trying to figure out what formulary changes were made for the insurers we see most often. It’s impossible to manage!”
Physicians and other prescribers have long been blind to how much their patients spend on prescriptions at the pharmacy. While prescription drug prices – and consumer costs – have increased steadily across the last decade, prescribers often recommend medications that they are familiar with, regardless of whether clinically viable, more affordable alternatives are available.
Across a practice’s population of patients, there can be a vast network of health insurers and a variety of available medications within specific plans. Moreover, since each patient is working against their own annual deductible, any guessing about medication cost, even when using generalized historical claims data, simply does not work.
Without RTPB in place, patients like myself typically find out their out-of-pocket responsibility for prescriptions at the pharmacy. Let’s walk through a few scenarios of what happens today:
- Patient arrives at the pharmacy and is told their copay is $200. The patient pays, perhaps not happily, and goes on with their day unaware that there were cheaper alternatives that could have saved them a significant amount of money.
- Patient arrives at the pharmacy and is told their copay is $200. The patient says, “I can’t afford that today – I’ll wait. Can I pick it up in a few weeks?” The prescribing clinician doesn’t know the patient is delaying their treatment, and depending on the condition, the non-adherence could have health implications for that patient and lead to quality score declines for the clinician.
- Patient arrives at the pharmacy and is told their copay is $200. The patient asks if there is a cheaper option, which starts an unnecessary workflow of call-backs where the clinician is informed she needs to start-over prescribing something else, and the patient has to either wait, or more likely, come back to the pharmacy at a later date. Treatment could be delayed, and all three parties: pharmacy, patient, and clinician are negatively impacted by the hassle.
There are likely a dozen other examples of how this situation could play out, some being dangerous to the patient’s health: maybe the patient pays for the costly drug, but decides to self-administer by taking ½ of the daily dose, or taking the drug every other day.
The good news? All of these scenarios are avoidable. RTPB brings personalized data to the EHR and provides coverage information in real time. Pricing is available to prescribers and patients, and better yet, RTPB can be turned on in a matter of hours. No longer do clinicians like mine have to try to remember which health plans covers which drugs for what amount of time. Instead, my doctor can focus on treating me when I’m in her office. She can focus on what is clinically best, regardless of my specific coverage. My out-of-pocket drug costs show up in the EHR while I’m with her, so we can have a meaningful conversation about what I’ll pay and what other on-formulary alternatives are available, long before I head to the pharmacy to pick up the medication.
Real-Time Prescription Benefit vendors like RxRevu are helping increase medication adherence and improve the patient financial experience at health systems across the country. I am proud to work at RxRevu, where we’re bringing data from the largest network of payer/PBMs to prescribers’ fingertips. By embedding technology seamlessly in the provider workflow and making it easy for providers to check coverage and cost information in real-time, we can help make price transparency a reality for every patient across the country.
Those who are interested in learning more about how to turn on RTPB at their organization are encouraged to reach out today.
Written by Lori Murphy MPH, Director of Provider Growth