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Federal Government Takes Action to Spur Greater Use of Prescription Price Transparency Tools at the Point of Care

December 18, 2018

On November 26, the Centers for Medicare and Medicaid Services (CMS) issued a Notice of Potential Rulemaking (NPRM) regarding the healthcare industry’s use of “Real Time Benefit Tools (RTBTs)” at the point of care.

According to the government, the CMS proposal in the NPRM is intended to “strengthen and modernize the Medicare Part C and D programs. The proposal intends to ensure that Medicare Advantage and Part D plans have more tools to negotiate lower drug prices, and also require pharmacy rebates to be passed on with the aim to lower drug costs."

From the CMS fact sheet “E-Prescribing and the Part D Prescription Drug Program” section:

“In order to accelerate the use of electronic Real Time Benefit Tools (RTBT) in the Part D program, CMS is proposing that each Part D plan adopt a provider (i.e. EHR-integrated) RTBT of its choosing beginning on or before January 1, 2020. 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."

As with any federal proposal affecting healthcare technology, the government is looking to the industry at large, including the Surescripts Network Alliance™ and the hundreds of healthcare organizations we connect, to review and provide comment. We are actively preparing our feedback in advance of the January 25, 2019 deadline.

Prescription price transparency that occurs at the point of care while the patient is in the doctor’s office fixes a major healthcare problem. In the past, prescribers have had to send their patients to the pharmacy with no insight as to what the medication will cost them out of pocket. This kicks off an administrative swirl that forces clinicians out of their regular workflows and onto the phone. While prescribers and pharmacists scramble to find an affordable alternative, care quality and efficiency, provider and patient satisfaction and safety all suffer.

We are thrilled to see the federal government recognize the need for prescription price transparency at the point of care. And providers are leading the charge by adopting prescription price transparency technology in droves. When this technology is used with e-prescribing and electronic prior authorization, it gives prescribers and pharmacists the power to successfully prescribe and dispense every prescription for every patient every time.

The Surescripts Network Alliance looks forward to helping shape the future of this technology and its ability to improve the safety, cost and quality of American healthcare.

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