MedCity Influencers, Health Tech

How real-time benefit tools deliver meaningful savings

In a rapidly changing and expanding healthcare environment, the secure exchange of health information and price transparency enabled by real-time benefit tools is critical to improve patient safety, lower costs and ensure quality care.

provider venture capital, money

Price transparency has evolved considerably since the Affordable Care Act went into effect more than 10 years ago. Following an extensive review and comment period by the industry, new rulings like the 21st Century Cures Act have expanded the exchange of electronic health information. At the same time, innovation and investment in new technology to support price transparency has skyrocketed, alongside continued efforts to drive down drug prices for consumers, such as the recently passed Inflation Reduction Act, authorizing Medicare to address drug price and premium increases.

Recently, the author of an article published in MedCity News, posed the question of whether real-time benefit tools (RTBTs) stemming from the Cures Act can help deliver savings to patients. The answer is that the access to price information provided by RTBTs at the point of care is central to improving healthcare quality and affordability. But with so many options available for patients, providers and payers, trust in the information being made available has never been more important.

As we enter our third year of the Covid-19 pandemic, we must acknowledge just how much has changed about the lives and needs of patients and the people who care for them. There’s no question that concerns around the cost of prescriptions is a growing challenge. In June 2021, 19% of patients said it had become harder to afford medications, while 82% of pharmacists and 66% of prescribers said the cost of prescriptions was one of the biggest issues in healthcare. At the same time, resources have been stretched thin in hospitals, doctor’s offices and pharmacies nationwide.

American healthcare professionals and organizations responded to all this change by solving for medication affordability and adherence up front. In 2021, those who engaged in secure exchange of health information enabled by RTBTs experienced not only increased transparency and efficiency but also meaningful savings—from our experience and data, this was $38.70 per prescription on average and $534.74 per specialty prescription on average. These savings add up, with most Americans filling more than 10 prescriptions each year. We can expect growth and expansion of RTBT adoption to continue, enabling more providers to gain access to patient-specific prescription drug costs and coverage information at the point of care without the need for burdensome phone calls and faxes. In turn, allowing more patients to receive timely access to the medication they need at a price they can afford.

Pharmacists and prescribers are very familiar with the relationship between a prescription’s out-of-pocket cost and the patient’s ability to adhere to their therapy, so it’s no surprise that they’ve embraced this new technology. But we also must acknowledge that adoption of new technology across the healthcare industry can at times be slower than some of us might wish. Given that it took nearly 10 years before this many prescribers used E-Prescribing, it’s remarkable to see how quickly providers have embraced this new technology. However, the market for price transparency tools has greatly expanded with new innovation and investment in the past 10 years.

RTBTs play an essential role in getting patients on their medications. According to a recent study, when patients experience even a $10 copay increase, this raises the likelihood of prescription abandonment by 10%. While not all RTBTs deliver price information directly from the patient’s benefit plan, those that do give prescribers and pharmacists the ability to consider therapeutic alternatives that are both clinically appropriate and affordable. And, when this information is integrated into the clinician’s workflow, it makes this essential cost saving information available to the clinician at the point of care, ultimately decreasing the chance of medication abandonment. Alongside benefits-based solutions, there are countless additional approaches to support the prescription decision, including manufacturer coupons, pharmacy savings programs, consumer apps that enable pharmacy shopping, and provider apps that support side-by-side comparison of both a benefits-based price and the cash price.

Surveys also show that consumers want greater access to price information, and in the last few years, there’s been a massive amount of venture capital funding in healthcare transparency companies to support this demand.

Yet, many patients still turn to the advice of their care provider who they continue to trust more than any other profession, according to recent studies. As a result, providers are often seeking out healthcare price information themselves. In a recent survey of physicians, 56% say accessing the out-of-pocket cost of medication is a high priority. But providers value cost transparency in all aspects of the healthcare journey, including 75% of providers who most value drug formulary data, 74% said it’s important to consider a patient’s medical benefit information, 59% reported they want to be able to compare the cost of similar medications, and 44% value having access to coupons, patient assistance programs or other sources of prescription cost information.

With patients increasingly seeking care from different providers in different locations, it’s more important than ever for healthcare professionals to have access to patient intelligence at the right time, in the right place, so that they have the trusted insights they need to best serve their patients. Giving providers better visibility into patients’ out of pocket costs for prescriptions is just RTBT’s help providers and patients make informed care decisions that decrease medication costs and increase adherence. And that’s how we think healthcare should be delivered.

Photo: adventtr, Getty Images

Adnan Qadir is the Chief Strategy Officer at Surescripts. In his role beginning in March 2019, Adnan is responsible for leading efforts to build, communicate and execute strategies vital to the success of Surescripts. He leads the strategy team in their work with internal and external resources to develop and create the strategy, taking into account market trends, key industry and regulatory drivers, competitive positioning, segment differentiation, and Surescripts’ operating capabilities. Prior to joining Surescripts, Adnan ran strategy, operations innovation, and new product development functions at DaVita, a Fortune 200 healthcare services provider. Prior to joining DaVita in 2016, he was a partner at Bain & Company, a global management consulting firm. He started his career as a database programmer for financial, technology, and healthcare clients. Adnan holds a BA in Biochemistry from Columbia University and an MBA from MIT Sloan School of Management.

This post appears through the MedCity Influencers program. Anyone can publish their perspective on business and innovation in healthcare on MedCity News through MedCity Influencers. Click here to find out how.