A pharmacist’s perspective on price transparency
Patient prescription costs can vary based on therapeutic generics available, brands with financial saving programs, a patient’s drug benefit coverage and negotiated pharmacy cash prices. Prescription price transparency enables everyone involved in the prescribing process to understand the pricing behind medications.
Price transparency creates visibility into the price variances based on a patient’s Rx benefit, the dispensing pharmacy and the pharmacy cash pricing with or without discount offers. Price transparency is connected, collaborative, informed and proactive; it links many stakeholders, including providers, patients, pharmacies, patient health benefit and pharmacy payers. It will offer real-time personalized pharmacy and drug-specific benefit data, in addition to the plan-level formulary and benefit information.
Using price transparency, a physician can see a patient’s formulary status and has the option to choose cost-saving alternative medications before writing a prescription. This real-time awareness of costs can help physicians have more productive conversations with patients about selecting medications at the point of care. In addition, physicians no longer have to keep hard copies of specific pharmacy savings programs such as the “4 dollar list,” that can require continual updating.
While the patient is at the center of concern for the costs of prescriptions, Pharmacy Benefit Managers (PBMs) are also heavily impacted. Real-time price transparency at the point of prescribing can help control the nation’s retail prescription drug cost problem, which totaled $328 billion in 2016. In contrast, billions can be saved by PBMs through the power of negotiation with pharmacies that, until now, providers and patients would not otherwise have visibility to.
A report from the USC Brookings Institute states, “A major cause of limitations in competitive generic drug pricing appears to be third-party payers’ lack of information about actual prices paid by retail pharmacies to wholesalers and manufacturers for generic ingredients.” Including aspects of negotiated pharmacy and PBM contracts that will bridge the information gap, enabling a better understanding for all stakeholders within the continuum.
Price transparency gives patients and providers the opportunity to weigh cost benefits against the benefits of staying with one pharmacy for all medication needs. Most retailers do not have access to competitor pharmacy records. A common drug-drug interaction, which could be seen when one pharmacy is used for dispensing all of a patient’s medications, could potentially be missed if prescriptions go to different pharmacies. With the added transparency, provider and patient can balance the benefits collaboratively, strengthening the provider-patient engagement experience.
A patient knowing a treatment is available but not being able to afford it can compound anxiety regarding a diagnosis. One study found that patients with a co-pay of $50 were nearly four times more likely to abandon a prescription at the pharmacy than patients paying $10. Price transparency simplifies the complexity of multi-tier plans and a confusing copay model with high deductibles or maximum out-of-pocket payments.
High or unknown costs can generate a high rate of script abandonment at the pharmacy, time delays for patient treatment due to phone calls back and forth with the provider seeking lower cost alternatives, or concern about patients compromising their treatment with pill splitting and skipped doses. Price transparency at the point of prescribing will greatly help to resolve these challenges. With the greater awareness of pricing information at the time of prescribing, starting the conversation up front between provider and patient regarding the Rx costs, and enhancing the provider-patient engagement of the treatment costs, I would expect to see a rise in adherence rates.
Allscripts Prescription Price Transparency™ will soon be available in Allscripts ePrescribe™. For more information, visit https://www.allscripts.com/ppt