Every day, payers and PBMs are looking for ways to drive value and improve care quality, while reducing costs. Real-Time Prescription Benefit (RTPB) can bring member-specific data to the point-of-care, helping providers make informed, low-cost medication decisions.

New regulation from CMS also mandates that plans covering Medicare Part D lives create networks to allow for the transfer of prescription coverage data. Many industry experts think that rules for commercial plans are soon to follow – making requirements for transparency even more widespread.

real time prescription benefit

But why take the time to turn on a Real-Time Prescription Benefit data feed? Below, we’ve outlined some of the benefits of RTPB and how payers and PBMs can quantify its value:

  • First, setting up a RTPB data feed can reduce administrative burden for payer and PBM teams. RTPB solutions can decrease the volume of tasks needed to be completed in conjunction with providers, and successful RTPB solutions can reduce prior authorization usage, alleviating time spent on clearance requests and processes. Additionally, instead of spending time on formulary communication and awareness, RTPB can automatically alert providers of covered medications and formulary alternatives in real-time – again freeing up time that could be better spent on other priorities.
  • Secondly, RTPB receives information from source-of-truth databases, making it possible to drive ideal prescribing behaviors that benefit both the member and PBM. For example, RTPB can increase on-formulary and generic prescribing. As a physician selects a medication, RTPB can alert them of clinically-viable, lower-cost alternatives that are covered under the member’s pharmacy benefit.  Further, best-in-class RTPB solutions can also display various fulfillment options in-workflow, allowing providers to see costs for retail and mail-order options – depending on which are preferred by the member or plan design.
  • Lastly – and most importantly – RTPB can improve member health and experience. Members are becoming healthcare consumers, often shopping for their care. They have become more cost-conscious and health plans that allow price transparency support are often selected over those who do not. Creating an environment where physicians can have affordability conversations drives member satisfaction, and provides a sense of empowerment to members.  Point-of-care price transparency also allows for reduced stick-shock when members reach the pharmacy, and can lower the overall cost of care when covered alternatives are available. RTPB has the ability to drive medication adherence for members as well, since lower-cost options are always preferred by members.  Research shows that even a $10 increase in member responsibility can significantly lower adherence across all member demographics (AJMC, P&T, P&T).  Therefore, reducing the cost of care is essential in getting members to follow to their prescribed medication plans.

Setting up a RTPB connection is an easy way to deliver member-specific data to provider workflows – where care decisions about prescriptions happen most often.  Reducing administrative burden, driving ideal prescribing behavior, and improving member health and satisfaction are only some of the benefits that payers and PBMs can realize by turning on this service.

If you are interested in learning more or want to explore how RxRevu can help you deliver relevant content to the point-of-care, please reach out today.

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