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Health Information Network Wins Partnerships with EHRs and PBMs to Provide Prescription Benefit Price Transparency and Electronic Prior Authorization

ARLINGTON, Va. – November 7, 2017 – Surescripts is again revolutionizing the prescription decision-making process between physicians and patients with its Real-Time Prescription Benefit and expanded Prior Authorization solutions. Having created the first true nationwide interoperability network with e-prescribing, Surescripts has continuously built upon it to offer an advanced prior authorization solution and a full range of capabilities designed to improve prescribing, inform care decisions and advance healthcare.

Surescripts is joining forces with six electronic health records (EHR) companies representing 53 percent of the U.S. physician base, and is leveraging information from pharmacy benefit managers (PBMs) CVS Health and Express Scripts, who represent nearly two-thirds of U.S. patients, to deliver patient-specific benefit and price information to providers in real time at the point of care. Once integrated with the EHR, the solution will also display therapeutic alternatives so that the prescriber and patient can collaborate in selecting a medication that is both clinically appropriate and affordable.

Prescription price transparency is critical to lowering patients’ out-of-pocket costs and preventing “sticker shock” and prescription abandonment at the pharmacy, a common cause of medication non-adherence which negatively impacts patient safety and costs an estimated $300 billion annually, according to the New England Health Institute. In just 12 months, Surescripts Real-Time Prescription Benefit pilot participants, including CVS and Express Scripts, generated 3.75 million transactions to test the functionality and validate the market demand for delivering patient-specific prescription benefit price data to prescribers in real time.

“Surescripts is leveraging the same network alliance we built to revolutionize healthcare with e-prescribing 17 years ago. Now, we’re deploying actionable intelligence to the exact point in the care process where patients’ prescription benefits can be optimized,” said Tom Skelton, Chief Executive Officer of Surescripts. “We’re once again at the forefront of a transformational moment in healthcare. Together with our partners, we’re delivering value back to the network in the form of greater price transparency and a streamlined workflow—two keys to patients getting the right drug at the right time, and at a cost that lets them start and stick with their medication therapy.”

When used together, Surescripts Real-Time Prescription Benefit, Prior Authorization and
E-Prescribing create the ideal scenario. For the first time ever, prescribers will be able to see what a medication will cost their patient, based on their specific health plan coverage, and pick the most affordable medication that meets the patient’s therapeutic need. Once the most appropriate and affordable medication is selected, if an authorization is still required, it may be quickly completed during the office visit within the EHR workflow. It is then sent to the pharmacy, resulting in the patient leaving the doctor’s office confident in both the medication choice and the medication cost, knowing that it will be covered by their insurance.

“We are excited about the prospect of being able to provide physicians and patients with information during the office visit, at the point of prescribing, which can enable them to select a medication that is both effective for the patient’s condition and affordable,” said Troyen A. Brennan, MD, Chief Medical Officer of CVS Health. “This visibility can help streamline the patient’s access to care and can ultimately help improve medication adherence.”

“Integrating timely, patient-specific information at the point of care is a key way Express Scripts is working to enable better physician decisions,” said Lynne Nowak, M.D., Vice President, Clinical and Provider Solutions at Express Scripts. “Particularly for our members in a high- deductible plan, clarity around prescription drug costs is vital. Surescripts’ real-time intelligence coupled with an automated authorization workflow will improve interactions between patients, physicians, pharmacists and benefit providers. It unlocks physicians’ ability to understand—in real time—the most appropriate and cost-effective treatment options for each patient. Combined, this technology improves the prescribing experience, increases patient access to more affordable medications, drives adherence and ultimately, creates better health outcomes.”

Surescripts Real-Time Prescription Benefit and Prior Authorization solutions require strong cross-market network alliances, which are already in place and expanding at an incredible rate. Surescripts prior authorization is currently available in EHRs representing 75 percent of U.S. physicians, and is connected to PBMs representing 85 percent of covered lives. Surescripts gained additional momentum with their recent agreement to partner with cloud-based EHR Practice Fusion to provide Real-Time Prescription Benefit and Prior Authorization. Allscripts, Aprima Medical Software, Cerner, Epic and GE Healthcare have also committed to offering Surescripts Real-Time Prescription Benefit to their users.

“When it comes to choosing the best medication, we believe in giving prescribers every available advantage within our platform,” said Tom Langan, Chief Executive Officer of Practice Fusion. “Surescripts’ NCPDP SCRIPT standard-based solution gives us both a functional and a competitive edge over others that use telecomm-based standards. And the ability to see what a particular drug will cost, plus real-time prior authorization, will relieve a lot of burden on both providers and patients, and improve satisfaction across the board.”

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