In 2019, major progress was made in delivering price transparency to patients nationwide, with nearly 250,000 prescribers leveraging patient medication cost information when prescribing, according to the new Surescripts 2019 Impact Report: Prescription Price Transparency. Real Time Benefit Tools (RTBTs), like Surescripts Real-Time Prescription Benefit, help improve outcomes, reduce costs, increase medication adherence and enhance patient and provider satisfaction.
“The dramatic growth of prescription price transparency technology is truly remarkable, and the impact on healthcare cost and quality is being felt among patients and the people who care for them,” said Tom Skelton, Chief Executive Officer of Surescripts. “There is no question that the entire healthcare industry is driving industry action to adopt tools that enable better-informed medication decisions at the point of care.”
Prescribers using Surescripts Real-Time Prescription Benefit are able to access patient-specific cost and coverage information, including out-of-pocket costs, prior authorization flags and therapeutic alternatives within their electronic health record. Prescribers use this information to talk to patients about choosing the best medication as part of a shared decision-making process that considers both clinical and economic factors. In one instance, the technology enabled a prescriber to save a patient as much as $8,032 on a single prescription.
According to the Surescripts report, using price transparency tools also eliminated the need for hundreds of thousands of prior authorizations in 2019—saving significant time for prescribers and patients, as most prescribers report waiting at least one business day for a single prior authorization decision from their patient’s health plan. In one month, when prescribers using Real-Time Prescription Benefit were presented with a prescription requiring prior authorization, along with an alternative without a prior authorization, they switched the drug 25.5% of the time.
With affordability driving the nationwide healthcare agenda in 2019, the federal government issued the Advantage and Part D Drug Pricing Final Rule (CMS-4180-F) requiring that Medicare Part D plans adopt RTBTs by January 1, 2021.
Prescription spending takes up 17% of all spending on medical goods and services provided directly to patients and is expected to grow by an average of 6.3% annually from 2017 to 2026, according to the Centers for Medicare and Medicaid Services. According to the American Journal of Managed Care, a $10 increase in patient copay also increases the likelihood of prescription abandonment.
That’s one factor contributing to medication non-adherence, which, according to Hospital Admissions Associated with Medication Non-Adherence: A Systematic Review of Prospective Observational Studies, causes up to 10% of hospital readmissions.
The Surescripts report shows that while the number of monthly benefit checks performed by healthcare providers at the point of care has increased substantially, utilization varies nationwide. Leading the charge is Washington, D.C., where nearly half of all providers have adopted the technology (49.9%). Also in the top five for provider adoption are Maryland (48.5%), Delaware (44.3%), North Carolina (36.4%) and Louisiana (36.2%). The bottom five states for provider adoption are New Hampshire (11.1%), Washington (10.2%), New Mexico (9.3%), Maine (8.8%) and South Dakota (8.3%).
To learn more about the impact prescription price transparency tools continue to have on the cost, quality and safety of healthcare, download and share the 2019 Impact Report: Prescription Price Transparency. Read this case study, Out in the Open: Price Transparency and 4 Forces for Optimal Prescribing, to learn more about one practice’s experience using the tool to save patients money on prescriptions.
Our purpose is to serve the nation with the single most trusted and capable health information network, built to increase patient safety, lower costs and ensure quality care. Since 2001, Surescripts has led the movement to turn data into actionable intelligence and convened the Surescripts Network Alliance™ to enhance prescribing, inform care decisions and advance the healthcare industry. Visit us at surescripts.com and follow us at twitter.com/surescripts.