CMS Price Transparency Rule is Fast Approaching

In 2019, the Centers for Medicare & Medicaid Services (CMS) issued its Medicare Advantage and Part D Drug Pricing Final Rule requiring Medicare Part D health plans integrate a real time benefit tool with at least one prescriber’s ePrescribing system or EHR, no later than January 1, 2021. CMS also mandated that all Part D plans send to patients an explanation of benefits that incorporates price transparency and less expensive alternatives once a month.

This rule is an effort by CMS – who recognizes the importance of improving the patient care and financial experience – to drive widespread adoption of price transparency tools. For this reason, this change will impact almost everyone in healthcare and shift expectations around drug affordability.

To remain competitive within the marketplace, EHRs will need to implement a real time benefit tool so they can help health plans meet the CMS requirement. Fortunately, EHRs shouldn’t view this as a hurdle since the technology and solution needed for compliance is already available. EHR vendors should instead view this as an opportunity to transform the prescribing landscape and support prescribers in the battle for affordable medications and medication adherence.

With this deadline less than five months away, Surescripts is ready to help EHRs satisfy the new rule's requirements and deliver accurate and reliable drug cost information through our Real-Time Prescription Benefit service. The use of Real-Time Prescription Benefit has skyrocketed over the last several years because of the growing demand by providers and patients for prescription price transparency at the point of care. Hundreds of thousands of prescribers are already using  the service nationwide, and the number continues to grow.

Surescripts Real-Time Prescription Benefit goes beyond price transparency: it also helps minimize workflow disruptions for prescribers, allowing them to spend more time with patients. And according to a recent survey on price transparency and the patient experience, prescription price transparency at the point of care affects patients' overall view of their care providers. More than half said it increases satisfaction with their provider as well as their likelihood of staying with that provider.

By requiring Medicare Part D health plans to adopt real time benefit tools, more patients will experience lower prescription drug costs, fewer beneficiary out-of-pocket costs, and increased medication adherence. Surescripts has been delivering true interoperability and enabling seamless information sharing for nearly 20 years and is excited to help the industry comply with the fast-approaching 2021 deadline.

Learn more about the positive impact of prescription price transparency and how Surescripts Real-Time Prescription Benefit solution can help you prepare for the 2021 CMS Price Transparency Requirements.