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Improving patient outcomes with medication affordability within the EMR

Patients often experience sticker shock at the pharmacy check-out counter. As a result, they are speaking up more and asking their pharmacist, “Can you call my physician to see if there are any less expensive medicines?”

These conversations are happening far too frequently, at the pharmacy – where little can be done. Unfortunately, without detailed patient history, pharmacists often do not have the detail and history to make these complex decisions on the spot.

Medication affordability is one of the biggest changes, over the past 15 years, in pharmacy benefits. When electronic prescribing began, patient cost information wasn’t a part of the dialog, but now it is an essential part of the successful prescription fulfillment process. The pharmacy benefit landscape has changed dramatically.

Years ago, most patients were on a flat 1- or 2-tier co-pay plan. As far as physicians and patients were concerned, prescription costs were predictable making it easy to calculate the out-of- pocket cost at the pharmacy counter.

According to a Veradigm Price Transparency Webinar, we are in an era where 71% of commercial lives are in high-deductible plans. This is a barrier to medication compliance and adherence, causing patients to demand information about cost and sometimes refuse medications they need.

That’s why the presence of patient-specific prescription drug pricing within the EHR is so important and powerful.

Patient consumerism – a powerful force for change

Price is obviously a potential barrier to every purchase made, and prescription medications are no exception.

In last 12 months, 3 in 10 patients declined to take a medication due to cost by either:

  • Just not filling prescription
  • Replacing it with an over-the-counter medication
  • Cutting pills in half or skipping doses

Even patients with serious conditions like cancer are often found to be non-compliant with their medications. A study in Journal of Clinical Oncology found a strong correlation to Rx price and Rx abandonment. As the cost of medications increase, patients are more likely to abandon their medications. About $50-100 is a major inflection point for the impact of out-of-pocket cost on adherence, even for cancer patients requiring life-saving medications.

With out-of-pocket healthcare spending growing by 40% from 2010-2014, patients are being hit hard. Patients see the costs of their prescriptions going up and want to be alerted earlier in the care plan development process.

At the same time, physicians are asking why they can’t have pharmacy information within the EHR. Price transparency gives physicians the opportunity to see medication price information and provides the ability to change to the chosen medication or the delivery location. The most important question is, “Will physicians utilize the medication cost information and then share it with patients given their work-load?”

How medication affordability works and why it’s so important

Price transparency goes beyond formulary information and co-pay amounts that typically have been available in EHRs.

Such information, while potentially valuable, isn’t robust enough for clinicians to make prescribing decisions due to variability within patient populations of a given pharmacy benefit. As a consequence, physicians tend to ignore that information and the patient only sees the out-of-pocket cost once they reach the pharmacy. Then, rework is required at the physician’s office and at the pharmacy potentially causing patient inconvenience, frustration and prescription abandonment.

An effective price transparency solution delivers patient-specific information about patient out-of-pocket drug costs within the EMR workflow:

  • Prices for selected drugs: both on plan or cash
  • Co-pay status based on deductibles to date
  • Prior authorization status
  • Price at pharmacy: preferred, retail, mail order
  • Prices at other pharmacies

The information is displayed automatically and passively within the providers normal EMR workflow, meaning no extra clicks or use of third-party applications is required – the information simply appears in the workflow with no additional user effort.

The physician is the enabler of change

Prescribers can do things differently now with this information. They can bring awareness of health plan for PBM pricing, cash pricing and therapeutic alternatives at preferred pharmacy and different pharmacies. All information is specific to the patient and within the current workflow. This starts the conversation with patients around cost and options.

Observed impact of price transparency for prescribers:
  • 93% found patient out-of-pocket savings
  • 85% felt it improved patient satisfaction
  • More than 50% said it prevented after-the-fact rework

Most patients are willing to look for alternative prices over therapy abandonment, and the prescriber is now in the driver’s seat to help patients make a more informed decision.

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