Patient medication adherence is a consistently discussed topic amongst provider organizations and health plans.  Every day, millions of patients avoid taking their medications because of inconvenience, stress, mistrust, or cost (AMA).  Some studies have even found that up to 50% of consumers skip or incorrectly take their medications because of one reason or another (APhA). In many cases, having medication cost and coverage information at the point-of-care would allow providers to have informed conversations with patients. However, provider non-adherence, especially to easily-accessible data, can lead to negative consequences and rework.

real time prescription benefit

When providers prescribe medications but do not leverage patient-specific data, they are inevitably causing downstream work and potential risk.  Real-Time Prescription Benefit (RTPB) technology can present coverage information at the point-of-care so providers can access out-of-pocket cost, copay, and deductible information, and avoid plan-specific restrictions (i.e. prior authorizations, quantity limits) and pharmacy callbacks. RxRevu, one RTPB vendor, has created direct connections with the nation’s largest payers and PBMs to bring the most accurate, real-time data to doctor’s fingertips.  We offer our EHR-embedded RTPB solution at no cost to health systems, so cost and quality-of-data are no longer excuses for provider non-adherence.

In addition to reducing downstream administrative burden for care teams, RTPB can also alleviate provider headaches and streamline the prescribing process in real time.  In many cases, quantity maximums are set by the patient’s plan or PBM (or in the case of opioids, by the state), but prescribers do not know these limits off-hand.  RTPB helps prescribers adhere to these restrictions so the patient doesn’t meet barriers when they go to pick up a medication. For example, if a patient’s insurance doesn’t cover a certain quantity of a drug, the patient must wait for the pharmacy and provider team to coordinate and fill a new, covered prescription. Other guidelines may be present in certain situations that are difficult to memorize, but are built into RTPB rules so providers can be alerted and continue the prescribing process without barriers.

Cost is another data point that is often requested by patients and providers at the point-of-care. For patients, getting the most cost-effective drug the first time is of the utmost importance to their health, and as previously mentioned, delays in prescription fulfillment can be avoided if providers leverage appropriate data.  If doctors are privy to patient plan data and adhere to best-practices, they can eliminate patient hurdles and improve the patient financial experience.  Knowing what the cost of a medication is upfront helps patients avoid sticker shock and can potentially reduce medication non-adherence.

One final example of how access to data via RTPB can benefit both patients and providers, is the ability to view several medication alternatives at once, without leaving the EHR’s prescribing workflow.  There are instances – if RTPB is not in place – when a provider might write numerous prescriptions to see which options are covered, and what the cost might be.  The act of writing ‘test scripts’ is risky, since voiding these prescriptions often gets overlooked, allowing patients to inadvertently pick up and take prescriptions that they do not need. RTPB often shows up to five formulary-driven alternatives, so doctors can see the cost of various medications before completing an order.

When thinking about ways to streamline the prescribing process, implementing an RTPB solution is the easy answer.  The accurate data that comes through a best-in-class Real-Time Prescription Benefit tool allows doctors to focus on what is clinically necessary, while observing guidelines, improving patient safety and adherence, and eliminating unnecessary burden.

To learn more about turning on RxRevu’s Real-Time Prescription Benefit solution in your EHR, reach out today.

Written by: Adam Rosenberg, Director

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