How much is this medication going to cost?
“It’s probably the most-asked question we get,” says Mehul Khakhkhar, owner and operator of Upgrade Pharmacy in Addison, Ill. “The reality is, pharmacists don’t have access to costs without taking additional steps. Wanting that information up front is reasonable, but we haven’t had access to it.”
Thanks to Surescripts new Real-Time Prescription Benefit tool, pharmacists can finally address prescription cost concerns with access to patient-specific benefit information, out-of-pocket prescription costs, and therapeutic alternatives at the point of dispensing.
Real-Time Prescription Benefit empowers pharmacists to seamlessly collaborate with patients and prescribers— in the dispensing workflow -- to find the right medication that is clinically appropriate, benefit-specific, and affordable, which is music to Khakhkhar’s ears. “This tool saves a ton of time and resources for our staff, from processing prescriptions, then reversing them, wasting supplies, returning meds to stock … Real-Time Prescription Benefit makes it so much more efficient.”
Half of patients report that they have not taken a medication because it was too expensive, and 3 in 10 have not taken a prescription because it took too long to fill, according to the Surescripts Prescription Price Transparency and the Patient Experience survey. “Patients start treatment for a chronic disease state and, often, we notice that, even if the prescription is on auto refill, they are still not able to successfully adhere to regimen. Those conversations revolve around high cost of copays and medications,” Khakhkhar explained.
"It's very reasonable to say cost leads to abandonment, so knowing that information up front and having the ability to locate other options leads to positive outcomes." -Mehul Khakhkhar, Upgrade Pharmacy
Pharmacy staff and personnel spend a lot of their time sorting through cost and benefit issues. Real-Time Prescription Benefit reduces time spent answering those questions and provides accurate information directly from the benefit plan.
According to Khakhkhar, who uses Real-Time Prescription Benefit in his BestRx pharmacy software, the tool is exceptionally useful for community pharmacists. “Often times we are the messenger between the insurance company, the prescriber’s office and the patient. So, before a prescriber sends us an electronic prescription, they may call to ask if we think it’s covered through a specific plan. This tool gives us insight into whether or not the prescription sent to us will be covered by that particular patient’s PBM [pharmacy benefit manager]. And if it isn’t covered, it offers alternative formulary options appropriate to the patient.”
With pricing, coverage and prior authorization information shared directly from the patient’s benefit plan, pharmacies now have insight into different days' supply and options on formulary that may be less expensive. In fact, Khakhkhar says Real-Time Prescription Benefit has been especially beneficial during the pandemic. “A patient’s copay may be the same or similar for a 90-day supply and a 30-day supply. With this tool, we were able to save a patient about $800 per year simply by switching them to a 90-day fill.” Plus, the longer supply means high-risk patients can avoid multiple trips to the pharmacy.
Prescription price transparency tools like Real-Time Prescription Benefit help pharmacy staff like Khakhkhar’s do their jobs much more effectively and successfully, and eliminate some of the challenges pharmacies face every day. “Best of all,” he says, “price transparency technology can help us achieve the best possible outcomes for our patients.”
Visit Surescripts Benefit Optimization page to learn more about our benefits-based price transparency tool and subscribe to Intelligence in Action to get the latest insights on prescription price transparency and other top issues in healthcare.