INTELLIGENCE IN ACTION

Federal Government Issues Final Rule: Part D Plans Must Adopt a Real Time Benefit Tool

May 20, 2019

On May 16, the Centers for Medicare and Medicaid Services (CMS) issued its final rule: Medicare Advantage and Part D Drug Pricing Final Rule (CMS-4180-F).

We’ve been closely following the provision of the proposal aimed at accelerating the use of Real Time Benefit Tools (RTBTs), such as Surescripts Real-Time Prescription Benefit.

This technology gives prescribers visibility to cost and coverage information within their electronic health record (EHR). With it, they can choose the best, most affordable medication in collaboration with their patient during the office visit. This replaces the tedious manual process of retrospective prescription drug cost comparison, which all too often involves back-and-forth phone calls between the pharmacist, prescriber and patient.

The proposed rule required the adoption of at least one RTBT by January 1, 2020, but the government received feedback that the timeline was too aggressive. While we at Surescripts recommended that CMS forge ahead with their proposed timing in the interest of helping patients, the deadline was indeed pushed out a year to January 1, 2021.

From the final rule: “In order to accelerate the use of electronic Real Time Benefit Tools (RTBT) in the Part D program, CMS is requiring that each Part D plan adopt one or more RTBTs that are capable of integrating with at least one prescriber’s ePrescribing system or electronic health record (EHR), no later than January 1, 2021. RTBTs have the capability to inform prescribers when lower-cost alternative therapies are available under the beneficiary’s prescription drug benefit, which can improve medication adherence, lower prescription drug costs, and minimize beneficiary out-of-pocket costs.”

Regardless of the timing, we fully support the government in its efforts to leverage prescription price transparency at the point of care. Healthcare providers want to get off the phone and back to caring for their patients. And patients deserve to know their out-of-pocket cost before they leave their doctor’s office. We know that when they do, they’re more likely to start and stick with their medications.

We are reassured by the remarkable response we’ve seen from prescribers, with more than 150,000 already using our tool today. And the impact has been felt by patients with one saving more than $8,000 on a single prescription.

Learn more about Surescripts Real-Time Prescription Benefit solution and the positive impact prescription price transparency is making on the cost, quality and safety of American healthcare.

Related Articles

September 08, 2020

Turning Personal Experience into Better Patient Outcomes

Luke Forster-Broten, Director of Product Innovation at Surescripts, sat down with me to talk about the importance of having the prescription cost conversation at the point of care—and how that idea helped inspire the development of our Electronic Prior Authorization solution.

Read more...
August 25, 2020

Three Ways Health Plans Can Address Inefficiencies and Medication Adherence

It is well known that Americans are grappling with rising health care costs and that all sectors of the health care industry have a role to play in addressing this issue. Read more...
August 13, 2020

Prior Authorization: On the Path to Quality, Affordability and Safety

In a recent survey by America’s Health Insurance Plans (AHIP), health insurance providers pointed to the automation of the prescription prior authorization process as a critical area in need of meaningful reform. Specifically, 84% of health plans identified automating the prior authorization process as one of the biggest opportunities for improvement. Read more...

INTELLIGENCE IN ACTION, DELIVERED TO YOUR INBOX