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Point-of-Care Price Transparency Needed for Patient Care Access

With 75 percent of patients experiencing "sticker shock" at the pharmacy, more providers need access to point-of-care price transparency tools.

price transparency

Source: Thinkstock

By Sara Heath

- Three-quarters of patients experience “sticker shock” when prescribed a medication that was more expensive than they anticipated, according to a new survey from CoverMyMeds. These results highlight the need for better price transparency and cost comparison tools at the point of care.

The survey of 1,000 patients and 1,300 providers noted the need for price transparency tools as more patients face high out-of-pocket healthcare costs.

Specifically, patients are incurring prohibitively high costs for their prescription drugs, the survey revealed. Fifty percent of patients did not fill a prescription because it was too expensive, while 37 percent of patients chose to discontinue use of a medication because it was too expensive.

These cost avoidance behaviors result in medication non-adherence, an extremely expensive problem harming the healthcare industry today. When patients do not take their prescribed medications, they run the risk of chronic conditions worsening and experiencing a costly and dangerous health episode.

“With high-deductible plans on the rise, many patients are required to pay more for their medications before they meet their deductible,” said Melissa Paige, Pharmacy Patient Medication Access Principal Coordinator at University of Virginia Health System, one of the survey collaborators. “Patients also have limited visibility into the cost of their prescription prior to leaving the provider's office, and as a result, are more likely to abandon their prescription at the pharmacy.”

READ MORE: Patient Advocates Call for Drug Price Transparency in HHS Blueprint

Price transparency tools, especially real-time benefit check tools, are an important tool for overcoming these high patient costs. Real time benefit checks are an extension of the physician EHR and provide information about the cost of prescriptions, patient assistance programs, co-pays as a part of a health payer plan, and other information that might affect the price of medication.

Seventy-four percent of patients said it would be helpful if they had access to cost information before heading to the pharmacy, and 87 percent said it would be helpful if their providers could offer this information at the point of care.

Currently, 83 percent of EHRs can show providers price transparency information. However, only about 57 percent of providers trust that data. This trend shows that providers need access to more reliable and comprehensive real-time benefit checks, the survey authors stated.

Patients, especially those enrolled in a high-deductible health plan, are getting their hands on cost information one way or another, the survey added. Forty-two percent of patients in a high-deductible health plan use third-party price comparison and price transparency tools to make decisions about where to purchase their medications.

However, these patient-facing tools are not always efficient because they can result in delays of care. A health consumer using a patient-facing cost compare tool must take the time between the office visit and the pharmacy visit to obtain this information.

READ MORE: CMS Updates Drug Price Dashboard to Improve Price Transparency

When a provider can offer price transparency data during a care encounter, a patient can immediately head to the pharmacy of her choice following the appointment, the survey authors indicated.

Much has been made of the idea of price transparency in this age of heightened patient financial responsibility. As patients assume more of the costs of their healthcare and medications, they are looking for the highest-quality and lowest-cost option.

Federal agencies such as CMS are currently calling for better price transparency in healthcare. Mandates under the IPPS and LTCH PPS final rules will require Medicare providers to publicly display their prices online for consumers to access. This will allow patients to make more informed decisions about where to access care, according to CMS.

And as a part of the Administration’s current efforts to quell patient drug costs, the Department of Health & Human Services has called on drug makers to make available the costs of their medications.

“American patients have the right to know what their prescription drugs will really cost before they get to the pharmacy or get the drug,” HHS said in its May drug pricing blueprint. “Too many people abandon their prescriptions at the pharmacy when they discover the price is too high, and too many patients are never informed of lower cost options.”

READ MORE: How Healthcare Orgs Offer Price Transparency to Patients

As the healthcare industry considers the problem of rising out-of-pocket patient costs, the focus will continue to shift toward more price transparency options. When patients understand the costs of their care, they can make more informed decisions about where and how they access treatment.

However, more must be done to reduce the overall costs of care. While price transparency will reduce the amount of “sticker shock” patients face when filling a prescription, it will not change a high cost.

Even if a patient is aware of the cost prior to their pharmacy visit, they still may not be able to afford a medication. The healthcare industry must continue its focus on lowering healthcare prices in order to combat this issue.

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