Real-Time Benefit Check, or RTBC, is the process of a provider using an app at the time of prescribing, within the exam room, to be able to look at the cost of the proposed medication, and alternatives, given an individual patient’s payer and subplan and deductible status.

Patients, more so than ever in the past, are experiencing sticker shock at the pharmacy when picking up a prescription. A 250 mg capsule of tetracycline that cost 6 cents per pill in 2013 jumped to $4.60 per pill two years later, a rise of more than 7,000 percent. A recent survey shows that one drug can have up to 900 percent variation in price nationally.

Therefore, even for a traditional inexpensive generic, you never know what the cost will be until you show up at the pharmacy counter. Until now. Now, through a platform like SwiftRx® Directoperating within the electronic health record workflow, pinging the system for a RTBC to determine immediate medication cost, the provider sees the cost for this proposed medication and similar alternatives, for this specific payer coverage, at the current cost of the moment. This information allows the patient and provider to have an immediate conversation as to whether that cost is reasonable or whether a lower cost alternative would suffice. The provider and patient can then make an informed purchasing decision no different than a consumer would do with Amazon.com. The exam room, which is the “point of sale” for prescription drugs, is the right place and right time for the decision to take place, not at the pharmacy window.

Providers have always been in the dark as to medication costs for an individual patient. Even when the current electronic health record designates a proposed med as “Tier 1,” which makes it seem likely to be an inexpensive medication, the provider has had low confidence that Tier 1 is up to date or actually means much, in light of confounding variables like high deductible plans, subplans within a major health plan, and frequent changes in formularies and drug prices. Ninety percent of providers say they would like to have knowledge of drug prices at the time of prescribing. Thirty percent of medications are not taken because of high drug prices. Pharmacy window sticker shock leads to call backs from the pharmacy to the provider to prescribe something less expensive, and such calls cost the medical practice time and money. Moreover, when prescriptions aren’t filled, there are delays in care, sometimes incurring more medical costs, and high dissatisfaction by both patients and providers.

Health systems set up drug formularies to guide their patients toward the most cost-effective choices, based on individual contracting for specific drugs (often through a Pharmacy Benefit Manager (PBM)). Unfortunately, this system is often ineffective within electronic health records that cannot perform a RTBC in the exam room. If non-formulary choices are made, not only does the patient lose out on cost-effectiveness, but the health plan also bears the brunt of higher than necessary drug spend choices. It is for the benefit of all parties, including the provider, patient, and payer that RTBC becomes a standard procedure during the time of prescribing. Health outcomes and medical loss ratios depend on patients taking medications, and patients taking medications depends on whether they can afford them.

RxRevu is a leading RTBC content provider dedicated to improving the value of healthcare through better prescribing decisions. The SwiftRx® Suite offers three solutions to promote cost transparency, improve patient satisfaction, and promote data-driven medication savings opportunities. To learn more about these prescription decision support solutions, contact RxRevu at contact@rxrevu.com or visit www.rxrevu.com/solutions.

By Kevin O’Brien, MD, Co-Founder and Chief Medical Officer, RxRevu

Please note that views expressed on this blog are those of the author and do not necessarily reflect the views of RxRevu. 

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