When your patients don’t feel well, you aim to figure out a diagnosis that can alleviate their fears of uncertainty. With the right price transparency tools, you can take determining a diagnosis one step further and alleviate their fears of uncertainty when it comes to prescription drug costs, too.

Let me explain why taking this step in your patient relationships is more important than ever for them and for your practice. I’ll also outline how you can enable drug price transparency at the point of prescribing and identify the clinical and business benefits that will flow to you, your patients and your pharmacy partners by taking this approach.

Complexity raises risk of non-adherence

If you’re like most physicians, new health plan benefit designs entering the market are likely overwhelming you—and you’re an experienced healthcare professional. Now think of how your patients must feel as they navigate through these complexities; in some cases with little to no knowledge while feeling less than 100% healthy or confident.

High-deductible plans, tiered drug benefits, prior authorization (PA) rules and changing drug formularies have their heads spinning. It’s rare that a patient knows the out-of-pocket cost for any drug you would prescribe for their condition. Not knowing how much a prescription will cost at the pharmacy is just one of the many barriers your patients face when trying to obtain medications.

As a result, most patients don’t know a prescribed drug’s out-of-pocket cost when they pick up a prescription at their local pharmacy. And the pharmacy counter is the last place they need to hear that the cost is too high, that their health plan doesn’t cover the drug, or that their health plan requires PA.

When those issues happen, there’s a good chance your patients won’t get the drugs they need. They may abandon their prescription at the counter. Or if they do pick it up and pay, they might not refill it. This all adds up to non-adherence and non-adherence leads to poor health outcomes for your patients.

Transparency at the point of prescribing

To address the risk of non-adherence, you can use transparency at the point of prescribing. This requires you to access your patients’ prescription drug benefits while they’re with you in your office.

By adding transparency tools that can be integrated into an EHR, you can access benefit coverage information in real-time. This is similar to what a pharmacist would see prior to submitting a prescription. When you can see this data in workflow, you’re able to discuss treatment options with your patients before they ever leave your office. The tools can tell you things like:

  • Whether the patient’s health plan covers the drug
  • The patient’s prescription drug benefits and coverage levels
  • Whether the patient’s health plan requires PA for the drug
  • How much the patient has to pay if they do not have coverage or pay cash
  • How much the patient will have to pay out-of-pocket for the drug
  • Whether there are lower-cost alternatives

If you can convey important prescription information to your patients during their office visit, your patients can avoid undesirable surprises at the pharmacy counter.

For example, if the patient’s plan doesn’t cover the drug you’ve prescribed, you can prescribe a therapeutic alternative that is covered by their plan. That’s better than them being caught off guard at the pharmacy and having to pay the cash price for an uncovered drug or the pharmacist having to call the prescriber to change the prescription, which could delay treatment.

Another example is when the patient’s plan does cover the drug, but it comes with a high deductible or high out-of-pocket cost. Your patient can decide in your office whether they can afford the drug that you want to prescribe. If not, you can modify the prescription with a less expensive alternative.

Further, you can address any PA requirements with a patient’s health plan and have those resolved before the patient walks up to the pharmacy counter.

If you can rectify as many issues as possible at the point of prescribing, your patients won’t have to deal with them at the point of dispense. That helps remove common barriers to patients’ access to drugs and increases the odds that they will receive their drugs as prescribed.

On a more personal level for your patients, transparency helps reduce the feeling of not knowing what to expect when they pick up their drugs. There’s that moment of truth when patients must make a personal choice in front of the pharmacist about whether they can afford their medication, or if they have to wait unexpectedly for PA to be resolved. That can be intimidating or embarrassing. A price transparency approach gives your patients more control over the situation and insight into their own patient journey as they navigate today’s complex healthcare system.

Including patients in decisions about their care is crucial. Patients benefit when they can decide in your office if they can afford the drug you want to prescribe.

How transparency benefits your patients

There are four players in this scenario: you, the physician; your patients; your patients’ health plans; and your pharmacy partners. By leveraging drug price and benefit transparency tools in your EHR at the point of prescribing, you create clinical and business benefits for all involved.

The most important element is the clinical benefit to your patients. By using your transparency tools, you:

  • Ease access. Your patients have easier access to the drugs they need to get healthy or stay as healthy as possible by removing unanticipated out-of-pocket costs as a barrier.
  • Reduce red tape. You’re helping your patients navigate obstacles like formulary changes or PA requirements. Those obstacles can delay life-saving treatments and lead to a decline in health or even death.

Your patients also benefit financially. For example, they can:

  • Save money. Patients can identify cost-prohibitive therapy options while still in your office and can work with you to find alternatives that they can afford to treat their medical conditions. That’s money that your patients can use for other purposes to help improve their health.
  • Save time. They also save time by resolving issues before they go to the pharmacy, rather than the pharmacy attempting to obtain approval while the patient is at the counter. That’s critically important for your patients, who may have to leave work to pick up their prescriptions. For most people, time is money.

How transparency benefits your practice

For you, transparency at the point of prescribing can add clinical value to each office visit. For example, it can:

  • Improve care continuity and coordination. The care you give your patients doesn’t end when the office visit ends. It continues with your treatment plan. By providing transparency into drug prices you can increase the likelihood that your patient gets and stays on your recommended drugs.
  • Address social determinants of health. When you talk to patients about the drug you want to prescribe and how much it would cost them, it can lead to other conversations about what’s happening in their lives that may be affecting their health.

By making each visit more valuable from a clinical standpoint, you’re also making each office visit more valuable from a business standpoint. That can happen in multiple ways, but here are two of them:

  • Patient loyalty and volume. You’re improving patient satisfaction and loyalty, which keeps patients under your care. They may also be inclined to bring family members or friends, increasing your patient recommendations, referrals and online reviews.
  • Risk payments. You’re providing price transparency and keeping patients healthy. Both can help you meet cost and quality targets in value-based care contracts.

Promoting pharmacy efficiencies

Another business benefit that can come from transparency at the point of prescribing involves your relationship with your pharmacy partners. By addressing things like coverage, benefits, price and PA in advance, your relationship with your patients’ pharmacies becomes more efficient.

It’s more efficient for you and your staff, because not only did you address potential issues in workflow, but pharmacies aren’t constantly calling about switching a patient’s drug because of a problem. You can stay in workflow.

It’s also more efficient for your pharmacy partners. They can also remain in workflow and eliminate rejections in their pharmacy management system. The end result is that your patients pick up the right drug at the right price because you have reduced or eliminated benefit investigations or PA requirements. Pharmacies will come to appreciate your practice’s decision to discuss drugs and drug prices with your patients during their office visits.

I realize that these conversations may be new to you and your practice. But helping patients with drug price transparency can improve their health outcomes and your day-to-day business. And one of the best ways you can approach drug affordability is through price transparency tools at the point of prescribing.

To learn more, read our industry report, Real-Time Benefit Check National Adoption Scorecard

Related: Learn more about McKesson’s pharmacy benefit cost transparency tools for physician practices

Stacy Hopkins

About the author

Stacy Hopkins is a Senior Product Manager for RelayHealth Pharmacy Solutions. She has more than 15 years of experience at RelayHealth where she has held positions in product management, implementations and financial analysis. She has a deep knowledge base of pharmacy workflow processes, business needs and technology solutions. 

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