If you’re looking to buy a house, you can find out the monthly payment nearly down to the penny before you even complete the mortgage application. In the market for a new car? You can show up at the dealership with at least an idea of the cost.
Isn’t it strange that with our prescription medications, we can’t do the same?
Patients must be able to discuss prescription prices during care
With Americans paying more than $1,000 per capita for prescription medications every year, and prescription transactions being the most consumer-facing part of the healthcare process, there’s no reason drug costs should be a mystery for patients until they reach the point of purchase.
Sticker shock at the pharmacy counter creates a ripple effect of negative consequences for both patients and population health, and it contributes significantly to the skyrocketing cost and inefficiency of the healthcare system. Nearly 40% of Americans say they’ve skipped filling a prescription due to cost and some 9 million report not taking medications as prescribed because they’re too expensive. Aside from the life-threatening implications of these decisions, medication nonadherence contributes to an estimated $300B in downstream healthcare costs.
If only patients and prescribers were aware of pricing – and possible alternatives that might cost less – at the point of prescribing. The problem is that no one really owns the patient workflow—yet.
It’s time to change behavior at the point of prescribing
Empowering patients with medication pricing information at the point of prescribing through a patient-facing digital experience solves multiple problems.
First, it allows patients more control. When patients can understand their drug cost and their payment options while still at the doctor’s office, it means they may not have to choose between their medicine and groceries that week.
Second, having this information up front can help improve the prescriber/patient relationship while reducing treatment delays and keeping patients on drug therapy. If a patient can access medication pricing on their smartphone, for example, they can discuss cost challenges in confidence with the prescriber immediately. The clinician doesn’t have to make socioeconomic or propensity-to-pay judgements about every patient. And, if a cheaper, equally effective medication exists, the patient can be alerted and ask to change the prescription while still at the doctor’s office – so the patients who need it can be empowered to engage. This also gets patients started on treatment sooner, rather than waiting for the pharmacist to call for an alternative.
Empowering patients can lower costs and improve outcomes
A patient-facing digital prescription experience also provides prescription portability and greater consumer choice by showing the current price of their medication at various local pharmacies. Instead of having all prescriptions sent to single pharmacy by default, patients can use the app to shop around, compare prices at different pharmacies and see the cost differential between using their insurance or paying the cash price (which can be cheaper). As a result, patients are more likely to pick up their first prescription and refills. This approach also gives the patient and prescriber essential data to consider other options beyond medication, which is especially important if the cost of the medication at the pharmacy would result in abandonment.
Price transparency benefits prescribers, payers and pharmacies, too
Putting patients in control with a digital prescription workflow also benefits prescribers, payers and pharmacies by reducing administrative burden and operating costs, helping to eliminate the back-and-forth coordination between the prescriber and pharmacy and freeing up more time for patient care.
For prescribers, lower cost drugs also mean better medication adherence and patient outcomes, which can help translate to fewer emergency department admissions, lower long-term care burden and costs and improved quality ratings.
It also enables better measurement, intervention and member service for prescribers. With a member-facing integrated digital prescription system, payers can now have the opportunity to track first fill and refill behaviors, so they’ll know if a patient doesn’t fill or refill a necessary medication. This offers unprecedented insight into the prescription process that currently doesn’t exist until the patient files a claim or re-visits a clinician for the same, untreated problem.
Payers can even demonstrate the value of their benefits. For example, even if a medication costs $100 out-of-pocket, if the member can understand that their insurance is covering $1,000 of the total cost, patients can see their benefits at work and may be more likely to fill it, recognizing the cost savings their benefits afford. And in the case of safe and effective alternative medications, payers can engage members at the point of prescribing to ask members to consider those less expensive alternatives – rather than after the fact.
Power to the patient improves the entire process
Patients deserve better than being blindsided by drug costs at the pharmacy counter. By giving patients and prescribers real-time pricing data at the point of prescribing, the entire healthcare ecosystem can benefit from more informed prescribing, greater efficiency, lower costs and empowered patients.
Tony Little, ND
Tony Little, ND, is SVP, Solutions Architecture forPrescryptive Health.
