HIT Think

How price transparency tools can benefit both providers and patients

The high cost of prescription drugs is literally bad for our health. According to a recent Kaiser Family Foundation study, many patients today are abandoning their prescriptions at the pharmacy or skipping or splitting doses when the cost is too high.

While the factors that go into the out-of-pocket price of medication are complex, until recently physicians had very little insights into the patient’s actual costs. Providers know medication price is important —prescribing decisions should balance the benefits, risks, convenience and costs in a manner that is optimum for each patient.

However, to date, the best surrogates for the actual price during the prescribing process are either learnings from past prescribing experiences or a formulary status which provides an indicator of a medication’s formulary tier and relative cost compared to other similar medications. Neither are effective long-term approaches.

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What if prescribers could have all of the patient-specific benefit information they need within their workflow before they complete a prescription?

Today, technology is transforming how providers and patients interact when it comes to prescribing. Price transparency services integrated into the electronic health record (EHR) software deliver patient-specific out-of-pocket costs during the prescribing workflow. As soon as the provider indicates the medication, quantity, and the patient’s choice of pharmacy, a pricing transaction is returned from the patient’s pharmacy benefit manager (PBM) indicating the exact price the patient will pay at the pharmacy.

While a powerful tool for patients and providers alike, there are three elements organizations must keep in mind to ensure provider adoption and success.

Integration into the provider’s workflow: Clinical informaticists have long known that the success of new technology is highly dependent on minimizing any extra work or additional time by providers. The optimum prescription price transparency service is directly integrated into the provider’s prescribing workflow, returns results within a second or two, and requires virtually no extra interactions in the EHR to see the information.

Actionable information to select alternatives: A patient may achieve similar outcomes with a different medication, so price transparency solutions should display alternatives that can save the patient money. The patient’s out-of-pocket cost can be reduced in a number of ways—choosing different medications in the same drug class, changing from a 30 to 90-day supply, or having the medication shipped from a mail order pharmacy. When an alternative is selected, the EHR should automatically update the prescription with the new information to minimize the amount of work by the provider.

Maintain the provider’s trusted relationship with the patient: One of the most important aspects of a provider-patient relationship is trust. When a provider informs the patient of the price, the provider must trust the price is accurate and based on the patient’s benefit plan, out-of-pocket spend for the year, and choice of pharmacy. The provider must be confident that the alternatives are presented in a neutral manner and not influenced by external forces that are trying to steer the provider’s choice. Simply put, the provider does not want the patient to learn at the pharmacy that the price information was incorrect or the medication chosen was not in the patient’s best interest.

From looking at medication choices and provider behavior, it’s clear. Prescription price transparency tools work. When presented with price information in the EHR, providers have been shown to choose prescriptions not only based on treatment, but also on cost. This saves patients significant amounts of money without sacrificing quality of care.

In fact, internists saved an average of $47 per prescription for patients when choosing an alternative while psychiatrists saved an average of $228. One patient even saved $8,032 for a single prescription.

The benefit for this type of tool also extends beyond saving dollars. Studies have repeatedly shown first-fill adherence is directly correlated to the patient’s cost—a drug that has a co-pay of greater than $50 has a 4.7 times greater chance of being abandoned, compared with a drug with no copay. Better yet, the relationship between provider and patient is enhanced as patients feel like the doctor is looking out for them by considering price in the medication decision.

Not only is this technology helping patients, but price transparency solutions are also saving providers valuable time by eliminating rework caused from changing a prescription after the office visit. Better yet, when used alongside electronic prior authorization, they are also saving time by, in many cases, avoiding the notoriously frustrating and burdensome manual prior authorization process altogether.

Prescription price transparency solutions are a new, important tool to help patients afford their necessary medications. In May, CMS issued a final rule requiring price transparency tools for prescribing to Medicare Part D patients by Jan. 1, 2021.

In response, most EHR vendors have enhanced their solutions to include real-time prescription benefit information within the prescribing workflow. With meaningful, measurable benefits to the patient, provider, office staff and pharmacy combined with an efficient implementation into the provider’s workflow, price transparency tools are expected to prove effective.

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