INTELLIGENCE IN ACTION

When It Comes to Choosing The Right Prescription Price Transparency Model—and Improving Member Care—Seven is the Magic Number for Innovative Health Plans

October 29, 2019

Just imagine: rather than the (unpleasant) surprise of a high copay or a prior authorization requirement, what if your members knew exactly what to expect at the pharmacy and how much their prescription would cost?

10 percent of patients abandon a medication because of cost.

Improving the member experience is absolutely possible, if health plans adopt the right price transparency tool for prescriptions. Prescription price transparency at the point of care can help combat a nationwide medication non-adherence problem that has been estimated to incur up to $300 billion in avoidable costs per year.

But how do you know the best solution for your members also works best for your organization? In our experience, here are the seven elements of an effective prescription price transparency model:

  1. Specifies patient out-of-pocket costs at point of prescribing
    Health plans should work to get cost and coverage information into the hands of prescribers so they can make a fully informed decision together with your members from the start, at the point of care. 
  2. Provides therapeutic alternatives
    Even a $10 copay increase can reduce medication adherence up to 10% for some patients, so it’s important for prescribers to be able to compare costs for different clinically appropriate options. 
  3. Doesn’t allow external influences to interfere with prescriber’s choice of therapy
    Your price transparency solution should never let outside interests promote or suppress a particular medication option. 
  4. Flags medications that require prior authorization
    Treatment delays can threaten medication adherence just as much as unexpected costs, so prescribers should be equipped to avoid prior authorization requirements and be able to choose a different drug if desired. 
  5. Leads seamlessly into the prior authorization process 
    Because time to treatment is so important, health plans should seek out price transparency solutions that not only display when prior authorization is required but integrate and automate the prior authorization process in the e-prescribing workflow. 
  6. Requires no extra work from members
    Most members won’t take the initiative to research drug costs ahead of time, or even know where to turn for reliable information. When price information is effortlessly available at the point of care, better choices and smoother experiences become the norm. 
  7. Based on real-time, patient-specific benefit data
    Estimates and third-party data sources can leave too much room for error. Cost and coverage data sent directly from health plans and pharmacy benefit plans is data members can trust. 

Visit us online to find out how you can transform the prescription experience for your members and prescribers.

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