In today’s world, as consumers, we can personalize nearly everything. On our way to work, with the swipe of a few buttons, we can customize a cup of coffee that will be waiting for us at the drive-thru window. We can pick a unique flavor combination that isn’t even on the menu, and we’ll know the price before we check out. Personalizing products, experiences, and even rideshares is part of our daily conveniences. So, why don’t we know how much our prescriptions will cost when we show up at the pharmacy? Consumerism is coming to healthcare. One of its forms is called Real-Time Prescription Benefit.
What is RTPB, anyway?
Real-Time Prescription Benefit is a step forward in drug-price transparency that allows patient-specific medication costs to be returned via a technology feed at the point of care. Through ePrescribing software like DoseSpot, once a medication is selected, it runs through an algorithm that evaluates insurance eligibility, formulary information, prior authorization requirements, pharmacy location, and other factors to pull back an exact out-of-pocket patient cost in seconds. It will even suggest lower-cost medicines used to treat the diagnosed condition that is covered within the patient’s prescription plan. This technology is quickly becoming more accessible. Here are four interesting facts about RTPB.
- Real-Time pricing is really “real-time.”
Other pricing tools have been known to use averages of previously adjudicated claims without considering different plan designs. RTPB is truly personalized and derived from data sources including payers/health plans and PBMs across the country. The data is then filtered through the individual’s benefits, even taking into account what phase they are in of their plan deductible. Change the pharmacy location, and there’s a good chance that the out-of-pocket cost will change too.
- It only takes $10 to affect medication adherence.
According to a study published in the American Journal of Managed Care (AJMC) when a drug copay is raised by just $10, medication adherence can be adversely decreased by 10%1. Many patients are managing multiple prescriptions, especially those with chronic conditions, and the numerous fills of those drugs over time can quickly become unaffordable. That’s when patients start to ration prescriptions and no longer take them as directed. RTPB gives you an avenue to discuss affordability with real alternatives. Even if the variety of drugs you prescribe is small, health plan coverages and different pharmacies can prove to have big variances in price.
- Prescribers report saving 90+ minutes per day with RTPB.
Surescripts surveyed physicians who were already using RTPB during patient visits in 2018 and found that only 14% of those surveyed reported spending more than 90-minutes per day adjusting prescriptions due to problems with the pharmacy compared to 30% who didn’t use it.2 Patients shouldn’t have to wait on needed medications; oftentimes the delays come because of miscommunication or confusion at the pharmacy. Patients abandon their prescription because it is too expensive, which requires prescription changes, additional research, and coordination between the physician, pharmacist, and patient. These minutes add up throughout the day, but many of these disruptions could be avoided altogether.
- RTPB will be available inside the DoseSpot application before the end of 2022.
Although RTPB isn’t available through all healthcare software solutions, DoseSpot integration will be turned on before the year’s end. The best part is that no additional training will be needed to use it. Providers can ePrescribe like they always do and after they select the drug, dose, quantity, days’ supply, and pharmacy, pricing information will immediately be returned. The solution will cover roughly 76% of the total patient population at launch.
If you are ePrescribing and cost information is not coming back, it is likely one of these three reasons:
- The patient doesn’t have prescription benefit coverage
- The patient’s benefit plan is not part of the Surescripts Network Alliance™ (coverage will expand as we move into the 2023 plan year)
- The patient’s eligibility and formulary coverage has not been added to the existing EHR
In recent years, provider adoption of RTPB has grown by over 1033%.3 If you want to deepen your patient relationships, discussing medication affordability is one way to do it, and soon the tools you need will be at your fingertips. No extra clicks or screens are required. Build trust by openly sharing expected out-of-pocket costs and suggesting alternatives when needed. A more personalized prescription experience is on the horizon. c
1Dana P. Goldman, Geoffrey F. Joyce and Pinar Karaca-Mandic, “Varying Pharmacy Benefits With Clinical Status: The Case of Cholesterol-lowering Therapy,”
The American Journal of Managed Care 12, no. 1 (January 2006).
2Surescripts/GLG Real-Time Physicians Survey – 2018.3Surecripts 2018 National Progress Report