Friday, August 23, 2019

Decreasing Prescription Abandonment with Price Transparency

Today’s guest post comes from Miranda Gill, Senior Director of Provider Network at CoverMyMeds.

Miranda discusses how high-deductible plans are making prescription drug patients behave more like consumers. As a result, patients want to know how much their prescriptions costs—before they pick it up.

CoverMyMeds offers RxBenefit Clarity, a real-time benefit check platform that is available in most electronic health records (EHR) platforms. Learn more in this new case study: Improving Prescription Decision Support with RxBenefit Clarity.

Read on for Miranda’s insights.

Decreasing Prescription Abandonment with Price Transparency
By Miranda Gill MSN, RN, NEA-BC, Senior Director of Provider Network, CoverMyMeds

Next week, thousands of leaders across the U.S. will come together to celebrate Epic’s 40th birthday and discuss future health care trends at Epic’s annual Users Group Meeting (UGM).

Among these trends is prescription medication cost and the need for price transparency to help patients afford and adhere to their prescribed therapies. Leaders from CoverMyMeds will attend Epic UGM to join this important conversation, highlighting how our newest integration in Epic’s native solution, RxBenefit Clarity™, equips providers and their staff with the most accurate prescription price information at the point of prescribing.

Discussing medication cost is a crucial milestone along a patient’s journey to wellness. With an uptick in Americans on high-deductible health care plans, out-of-pocket expenses grow in importance. Patients often make decisions about their health care based on what they’re able to spend, even opting out of prescribed treatments if they can’t afford them.

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According to a survey of 1,000 patients, 75 percent have been prescribed a medication that cost more than they expected. Consequently, half reported that they have avoided filling a prescription because it cost too much when they arrived at the pharmacy, while 37 percent reported that they stopped taking a medication because of the refill cost. The rate of medication nonadherence contributes to billions of dollars each year in avoidable health care spending, including costs related to emergency department visits and hospital readmissions.


Health care is trailing behind other industries in terms of offering full transparency to consumers, though the industry is making strides in the right direction as patients become more intentional about health care spending.

High-deductible health plans continue to rise in popularity annually, and so do out-of-pocket health care expenses, reaching over $330 billion annually.

This increase has caused providers to shift their style and view patients as consumers, recognizing their desire for clarity in terms of cost, billing and benefits. This “consumerization” mindset puts more power in patients’ hands, with the understanding that they can decide where and when they receive care, whether or not they adhere to their prescribed therapies, and where they choose to fill their prescription.

In other words, patients are paying more, and thus paying more attention.


Prescription cost is the top cause of medication abandonment, making price transparency at the point of prescribing critical to successful treatment.

Providers and their staff are often the only stakeholders to connect with patients before they arrive at the pharmacy. When armed with accurate pricing information, they can help reduce prescription abandonment by setting realistic expectations around prescription cost, helping to alleviate patient sticker shock.

Solving for prescription price transparency seems straightforward enough: inform patients about medication costs at the point of prescribing, and determine if it is affordable to them. However, visibility into reliable prescription cost information is multi-faceted and complex. It becomes especially confusing when providers have access to several prescription price technologies, known as real-time benefit check platforms, without a clear understanding of which platform best suits each provider’s needs.

A key factor for a successful real-time benefit check implementation is whether the solution can surface precise and accurate medication costs prior to prescription submission within the provider’s EHR. Our own real-time benefit check platform, RxBenefit Clarity, is available in over a dozen EHRs including Epic. In a recent RxBenefit Clarity case study, one of the largest EHRs in the market reported a 97 percent accuracy rate for prescription cost, which has helped improve medication adherence by nearly 20 percent.

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Providers across the country utilize RxBenefit Clarity more than 20 million times each month to display medication alternatives and the lowest prescription cost through comprehensive analysis. Comparatively, similar solutions average less than 3 million prescription benefit transactions per month.

One of our primary goals in participating in prescription price transparency is to work toward driving down the overall cost of care, starting with empowering providers and patients to have more informed conversations about medications.

If the cost of the medication is too high for the patient to afford, providers can recommend alternative, clinically appropriate medications that meet the patient’s affordability needs as well as complete prior authorization requests in real-time, helping to decrease time to therapy. In some cases, providers can also determine if there are available patient assistance programs to help the patient pay for their recommended prescriptions.


Other health care stakeholders are also directly affected by the demand for transparency. The Department of Health and Human Services announced in early May a new rule requiring pharmaceutical companies to include medication list prices in television ads for prescription supplies equal to or greater than $35 per month. This rule was later struck down in court, but the sentiment remains: Transparency is in high demand.

As we work toward an industry of transparency, we have better health to look forward to as a result. Price transparency encourages patients to become more engaged with their clinical experiences and research shows that a conversation as short as one minute can save patients money. The resulting cost savings can result in long-term patient provider trust, medication adherence and improved health outcomes.

For more information about prescription price transparency and how informed patients lead to better health outcomes, visit the 2018 Real-Time Benefit Check National Adoption Scorecard.

You can also download our new case study: Improving Prescription Decision Support with RxBenefit Clarity

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