The number
of providers using a drug price transparency tool has increased by over 1,000
percent, improving the patient financial experience.
By Sara Heath
February 12, 2019 - Providing point-of-care drug price
transparency may be getting closer to a reality, as more providers adopt the
technology necessary to view such information, according to a Surescripts report released this week at HIMSS.
Price transparency tools are key for reducing the blow of
pharmacy sticker shock and helping to identify lower-cost options.
“With prescription price transparency tools at their
fingertips, prescribers are eliminating pharmacy callbacks, improving
medication adherence, and reducing costs,” said Surescripts CEO Tom Skelton
said in a statement. “And their patients are getting the
medications they need, at an affordable price, faster and with less hassle.”
Providing price transparency has become an integral part of
improving the patient financial experience and helping providers better
prescribe effective medications and treatments, the report revealed.
Eighty-seven percent of providers said that understanding
their patients’ prescription drug costs was at least a moderate challenge.
Meanwhile, over three-quarters (78 percent) of providers said helping patients
understand their financial liability for a medication is a priority. Sixty-nine
percent of clinicians said it’s important to have access to information about
lower-cost drug options.
Furthermore, manually prescribing medications is a timely
process. Clinicians spend two hours a week consulting with patients about medications and
costs, 1.7 hours working on prior authorization forms, and an hour working to
understand drug pricing for patients, the report authors noted.
Price transparency tools, especially those that integrate
directly into the EHR, present an opportunity for efficiency. These tools must
provide patient-specific information – information about generic alternatives,
prior authorization requirements, and out-of-pocket patient costs – to provide
useful insights for providers.
More providers are accessing these types of price
transparency tools, Surescripts reported. Provider use of the Real-Time
Prescription Benefit tool, which is Surescripts’ price transparency technology,
grew by 1,383 percent between 2017 and 2018. The most common specialties using
the tool included family medicine, obstetrics and gynecology, psychiatry, and
cardiology.
Price transparency queries have also increased in 2018. The
number of drug cost checks totaled to 6.3 million in December 2018. In January
2018, that number was at 298,000.
These numbers are likely the result or more EHR vendors that
have created capabilities by which providers can plug in the price transparency tool. Currently, 80 percent of
EHR vendors have allowed this capability, making prescription drug price
transparency a reality for 76 percent of patients.
Better access to price transparency tools has resulted in
lower out-of-pocket spending for patients. The average per patient cost savings
in psychiatry was $228, the report authors noted.
The price transparency tool was more useful for some drugs
more than others. For example, using the tool to identify a lower-cost generic
saved patients taking an anti-depressant an average of $105. The tool saved
patients taking blood glucose-lowering medication an average of $88.
These cost savings came from providers identifying
less-costly alternatives.
“The real value that this tool provides is the ability to
make a more informed prescription decision and to be able to set expectations
up front,” said practicing dermatologist Michael Sherling, MD, Chief Medical
and Strategy Officer at Modernizing Medicine. “The impact we’re having with
prescription price transparency is an exciting demonstration of what technology
can deliver when the right areas of healthcare are convened, aligned and
working together to fix a major problem facing patients and providers.”
Healthcare providers are also using technology to streamline
the prior authorization process. Prior authorization, which is a utilization
and cost control strategy, can potentially delay patient access to care and
treatment.
A 2019 survey from the American Medical Association
(AMA) revealed that 91 percent of doctors have seen prior authorization delay
patient care access. Sixty-five percent said they have had to wait at least one
business day to hear back from an insurer about a prior authorization decision.
Twenty-six percent said they have had to wait at least three business days.
When providers use the price transparency tool, they have
the opportunity to see which treatments require prior authorization. When
clinicians had a drug option that did not require prior authorization, they
chose that alternative 28 percent of the time. This functionality eliminated
158,000 hours of potential waiting time during December 2018 alone, the report
noted.
More providers are also using streamlined technology to help
with the prior authorization process when confronted with
it. By the end of 2018, 77 percent of EHR had adopted a prior authorization
streamlining tool. Family practice, internal medicine, psychiatry, pediatrics,
and neurology were the most common specialties to adopt this tool.
As patients continue to bear the burden of rising drug
costs, clinicians will be looking for solutions to ease the financial
experience for them. Offering drug price transparency will be critical for
selecting lower-cost therapies and easing the blow of pharmacy sticker shock.
“Tools that enable prescription price transparency and
automated prior authorization will continue to make a measurable impact on
clinicians and their patients,” the report concluded. “Our industry is on the
right path. But there’s more work to do. To realize the full potential of
prescription price transparency, we must continue working to connect EHRs,
clinicians and patients nationwide.”
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