INTELLIGENCE IN ACTION

From Powerless to Empowered: Solving the Drug Cost Conundrum for Patients, Prescribers and Pharmacists

Picture this: A doctor and their patient are looking at a computer screen. The doctor explains the available medication options, including the exact out-of-pocket cost associated with each, based on the patient’s specific drug benefit. The patient says, “I am OK with $10 today, but if it’s $50, I can’t do it.” They choose the $10 option. The patient picks up her medication and begins treatment later that day.

It sounds simple enough, but this crucial cost conversation is only possible when everyone—not just the prescriber—plays their part. Otherwise, what should have been a drug cost conversation becomes a drug cost conundrum: a patient who needs her medication but can’t get it because of the cost. Her condition worsens, she ends up in the emergency department, and is admitted to the hospital.

And then come more bills that she also can’t afford to pay.

She feels powerless, defeated and abandoned by a healthcare system she trusted to meet her where she was—both physically and financially.

Watch this: Medication only works if patients can afford to take it

Until recently, healthcare providers have lacked the tools to easily select and prescribe medications that they're confident their patients can access, afford and adhere to. What should be a simple process—getting patients started on an optimal medication—has been hindered by heavy administrative burdens across the entire healthcare system, from prescription rework to inefficient prior authorizations and the resulting treatment delays.

We’ve connected with thought leaders from across healthcare for their insights on our collective responsibility to set the stage for honest and effective cost conversations at the point of care.

Michelle Forbes, M.D., MD Pediatric Associates uses Surescripts Real-Time Prescription Benefit as part of Veradigm RxTruePrice™, the price transparency feature of her electronic health record (EHR). She said: “Medication adherence begins with a shared decision-making process between the prescriber and their patient, and it must be informed by delivering accurate and patient-specific cost and coverage information at the point of care. Using the price transparency tool keeps the medication decision-making process in the exam room, where it belongs—between my patient and me.”

Michael Sherling, M.D., Chief Medical and Strategy Officer at Modernizing Medicine and a practicing dermatologist said: “The real value that this tool provides is the ability to make a more informed prescription decision and to be able to set expectations up front. The impact we’re having with prescription price transparency is an exciting demonstration of what technology can deliver when the right areas of healthcare are convened, aligned and working together to fix a major problem facing patients and providers.”

Priyank Patel, owner of Felicity Pharmacy who uses Surescripts Real-Time Prescription Benefit as part of Micro Merchant Systems’ PrimeRxTM Pharmacy Management System said: “We saw an immediate benefit. With the push of a single button, our staff now has immediate access to each patient's benefit information. Information that used to require multiple steps and several minutes to gather now appears right away."


 

Brian Caswell, Owner of Wolkar Drug, said: “As the nation responds to the COVID-19 pandemic, pharmacists are primary points of care in dispensing needed medications, providing testing and counseling patients. With access to real-time, benefits-based prescription price information at the point of dispensing, pharmacists can help patients optimize the safe and effective use of their medication treatment at an affordable cost.”

Luis Rodriquez, Chief Executive Officer of Keycentrix said: “Pharmacists understand the drug interactions and the implication on patient care. They also know how to discuss that with a patient. I think a lot of our customers aren't just putting pills in a bottle and handling them. They are—before you even get the pill bottle—considering what works best for you. And then, on top of that, they have a kind of social work element to it, because if you can't afford the drug, what do we do?”

Lynne Nowak, M.D., Vice President of Evernorth and General Manager of Clinical, Data and Provider Solutions at Express Scripts said: “Innovation cycles that would typically take several years are being completed in a matter of months. The demand for things like access to critical data no matter where a patient shows up, full transparency on the cost of prescription medications and a shortened journey to get a patient started on a specialty medication will only intensify as well."

Troyen Brennan, M.D., Executive Vice President and Chief Medical Officer at CVS Health said: “We’re pleased to be helping to elevate the conversation around prescription drug cost transparency and informed healthcare decision-making. The availability of member-specific drug cost information in the EHR points to a truly advanced prescribing experience that is helping to make medicines more accessible and affordable for consumers.”

Steve Miller, M.D., Chief Clinical Officer at Cigna said: “We want to change our customers’ lives for the better. Improving communication and information sharing with prescribers at the point of care can make the biggest difference for the entire care continuum. We look forward to advancing the conversation around how we can give more prescribers access to real-time cost and therapeutic information to help them save their patients money, time and frustration at the pharmacy.”

Delivering More Affordable Prescriptions

At Surescripts, we’re leaning into both our responsibility and our unique capabilities to help providers deliver more affordable medications. By enhancing the prescribing process, Surescripts helps improve medication adherence and time to therapy.

Through a single workflow-integrated connection to the nation's most trusted and capable health information network, clinicians access patient-specific pricing and coverage information straight from the source: the patient's benefit plan. They can view out-of-pocket costs for the selected medication and multiple therapeutic alternatives. Medications requiring prior authorization are flagged, and prior authorization can be initiated within the same workflow. If a patient’s benefit information isn’t available or the patient doesn’t have insurance, prescribers may see a price based on other payer programs that the selected pharmacy has selected. All of this comes together to get patients the right medication at the right cost, quickly and efficiently.

Together, we’re building the future of e-prescribing with innovations that enhance the entire prescribing process. And we’re shifting from powerlessness to empowerment by eliminating sticker shock and knocking down barriers to safe, effective and convenient care.

Visit Surescripts.com to see how we support every area of healthcare in delivering safer, more efficient and more affordable medications that patients can access and adhere to.

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