Price transparency has evolved significantly since Affordable Care Act entered into force more than 10 years ago. After an extensive review and industry comment period, new solutions such as 21st Century Cures Act expanded the exchange of electronic health information. At the same time, innovation and investment in new technologies to support price transparency have risen sharply, along with ongoing efforts to lower drug prices for consumers, such as the recently enacted Inflation Reduction Actauthorizing Medicare to address increases in drug prices and premiums.
Recently, article author published in MedCity News, questioned whether real-time benefit tools (RTBT) stemming from the Cures Act could help save patients. The answer is that access to cost information provided by RTBTs at the point of care is fundamental to improving the quality and affordability of health care. But with so many options available to patients, providers and payers, trusting the information provided has never been more important.
As we enter our third year of the Covid-19 pandemic, we must recognize how much has changed in the lives and needs of patients and their caregivers. There is no doubt that concerns about the cost of prescriptions are a growing challenge. In June 2021, 19% of patients said it had become harder to afford drugs, while 82% of pharmacists and 66% of prescribers said the cost of prescriptions was one of the biggest problems in healthcare. At the same time, resources in hospitals, doctors’ offices and pharmacies across the country are stretched thin.
American health professionals and organizations have responded to all of this change by addressing medication availability and adherence in advance. Adoption of RTBT may lead to a no. Those who participated in RTBT-enabled secure health information exchange saw not only increased transparency and efficiency, but also significant savings—in our experience and data, this averaged $38.70 per prescription and averaged $534.74 of a prescription for a specialty. These savings add up, with most Americans filling more than 10 prescriptions each year. We can expect the growth and expansion of RTBT adoption to continue, allowing more providers to access patient-specific prescription drug cost and coverage information at the point of care without the need for burdensome phone calls and faxes. In turn, allowing more patients to get timely access to the medicines they need at a price they can afford.
Pharmacists and prescribers are well aware of the relationship between the cost of a prescription and a patient’s ability to adhere to their therapy, so it is not surprising that they have embraced this new technology. But we also have to recognize that the adoption of new technologies in the healthcare industry can sometimes be slower than some of us would like. Considering that it took nearly 10 years for so many prescribers to use e-prescribing, it is remarkable to see how quickly providers have embraced this new technology. However, the market for price transparency tools has expanded significantly with new innovations and investments over the past 10 years.
RTBTs play an essential role in directing patients to their medications. According to a recent study, when patients experience even a $10 copayment increase, it increases the likelihood of abandoning a prescription by 10%. Although not all RTBTs provide pricing information directly from the patient’s benefit plan, those that do allow prescribers and pharmacists to consider therapeutic alternatives that are both clinically appropriate and affordable. And when this information is integrated into the clinician’s workflow, it makes this essential cost-saving information available to the clinician at the point of care, ultimately reducing the chance of medication abandonment. Along with benefit-based solutions, there are a myriad of additional approaches to support the prescribing decision, including manufacturer coupons, pharmacy savings programs, consumer apps that enable pharmacy shopping, and provider apps that support side-by-side comparison of both price, based on benefits and cash cost.
Studies also show that consumers want more access to price information, and in the past few years there has been a huge amount of venture capital funding in healthcare transparency companies to support this demand.
Yet many patients still turn to the advice of their care provider, whom they continue to trust more than any other profession, according to recent studies. As a result, providers often seek information on healthcare prices themselves. In a recent survey of doctors, 56% said access to out-of-pocket drug costs was a high priority. But providers value cost transparency in all aspects of the healthcare journey, including 75% of providers valuing formulary data the most, 74% saying it’s important to consider patient medical benefit information, 59% report wanting to be able to compare costs of similar medications and 44% value with access to coupons, patient assistance programs, or other sources of prescription cost information.
As patients increasingly seek care from different providers in different locations, it is more important than ever for healthcare professionals to access patient information at the right time and in the right place so they have the reliable insights they need. to best serve their patients. Giving providers better visibility into patients’ out-of-pocket costs for prescriptions is just how RTBT helps providers and patients make informed care decisions that reduce drug costs and increase adherence. And that’s how we think healthcare should be delivered.
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