Patient Responsibility News

76% of Patients Benefit from Drug Price Transparency Technology

The number of providers using a drug price transparency tool has increased by over 1,000 percent, improving the patient financial experience.

drug price transparency

Source: Thinkstock

By Sara Heath

- 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.

READ MORE: Verma: Price Transparency Rule Critical First Step for CMS

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.

READ MORE: Price Transparency Rules Take Effect, Slated to Empower 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.

READ MORE: Top Strategies for Collecting Patient Financial Responsibility

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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