A pharmacist’s perspective on drug price transparency and the future of healthcare
One of the more rewarding aspects of being a pharmacist is the opportunity to help individual patients become better advocates for their own health and wellbeing. It is important to make time for direct patient care even though high prescription loads and staffing shortages can pose a significant time constraint.
As technology advances, I see tremendous opportunity to consult with patients about how best to research and then discuss medication options and alternatives with their physicians. The goal is always transparency on two equally important topics: What will it cost and what’s the most effective course of treatment?
Unfortunately, at this time, pharmacists are not equipped with the same software physicians use that enables them to compare the price of a prescribed medication at different dispensing locations. If that were to become available, it could also be used to identity high-risk patients by evaluating the number of meds they are on and the overall cost.
That same discussion is being played out on a much larger scale now in the ongoing national debates over prescription drug prices.
On May 8, 2019, the U.S. Department of Health and Human Services finalized its rule requiring drug manufacturers to disclose drug prices within direct-to-consumer advertisements. The direct-to-consumer Ad Drug Price Transparency Rule is intended to improve price transparency and tackle high out-of-pocket patient drug costs.
The advertisement is mandated to disclose the following statement: “The list price for a [30-day supply of][typical course of treatment with][name of prescription medication or biological product] is [insert list price]. If you have health insurance that covers prescription medications, your cost may be different.” I anticipate the sticker shock will encourage patients to start conversations about medication costs with their physician or pharmacist.
Earlier, on April 9, 2019, the Prescription Drug Sunshine, Transparency, Accountability and Reporting (STAR) Act of 2019 was passed by the Ways and Means Committee.
This act would help improve accountability and ensure health plans, hospitals and health systems, manufacturers, patients, clinicians and taxpayers have a further understanding of key issues related to transparency and public reporting of clinical and financial information.
The STAR ACT’s three main components
1. Price transparency
Pharmacies will now be required to inform patients of their out-of-pocket drug cost (cash price) at the point of sale rather than their insurance-assisted out-of-pocket or co-pay costs. Unlike current practice, if patients choose to pay out-of-pocket, the total cost would be applied directly to their deductible. EHRs are now building this technology directly into the prescribing workflow to enable physicians to go over all financial options with the patient before submitting a prescription.
Making this work at the point of sale will induce a learning curve by both the technician and pharmacist, as they are asked to review the required price details while continuing to properly manage other customers waiting to pick up or drop off medications. It will be important that they also develop a better general understanding of the complexities of insurance plans and how their payment structure works. This is usually a skill that can be picked up hands-on rather than taught from a book, but it will take some time.
The STAR ACT will enable patients to become smarter consumers. Insurance companies must inform patients of the total costs of their prescription medications 60 days prior to open enrollment. The cost to the patient will be locked in place for a full 12 months to help give fixed-income patients reassurance that the prices will not abruptly increase.
If this information becomes better known and more predictable, prescription medications could be budgeted just like any other household bill, such as rent, mortgage, water, vehicle insurance, etc. Setting such an expectation up front can have a direct clinical benefit for patients, helping decrease issues with adherence.
Drug manufacturers will no longer be able to charge American consumers more for prescription medications than they charge consumers in other countries, such as members of the EU or Australia. This ruling will be terminated after 5 years.
Currently, thousands of Americans reach out to other countries to purchase their medications at a cheaper rate, but this raises questions of patient safety as consumers are hesitant of the purity of products from outside the US. Leveling the playing field with price should help patients better trust the quality of the medication while increasing their ability to afford the medications locally.
The same technological, cultural and economic forces that have increased consumer power in other industries (e.g. the ability to comparison-shop for everything from gas prices to mortgage rates from your phone) are fueling the growing empowerment of patients in the healthcare industry. If the STAR Act becomes law, combined with the new HHS rule on drug price disclosure in consumer advertising, the momentum behind prescription price transparency will only accelerate further. This would hopefully then lead to the next steps of making the same pricing information available in other areas of healthcare that can cause sizable financial burden, including images, lab tests, biopsies, procedures, etc.
Allscripts is proud to be in a leading position in the effort to accelerate patient empowerment, delivering physicians the solutions that can strengthen the patient-provider relationship through communication. To learn more about emerging trends and technologies related to prescription price transparency and medication affordability, view this infographic.