In a 2022 survey, 1 in 4 patients reported difficulty affording their prescriptions—which rose to 1 in 3 of those taking four or more prescription drugs. Anxiety around drug costs was even more common: 43% said they were at least somewhat worried about being able to afford prescriptions for themselves and their family.1
This has stark consequences for medication adherence. Patients with cost concerns may cut or skip doses—if they pick up their prescriptions at all. If the medication requires prior authorization, they and their care providers must hope that the process doesn’t hit a snag.
The burdens of worry and rework become far lighter when prescribers and pharmacists can see prescription cost and coverage information throughout the care journey. By providing access to patient-specific information and the power to efficiently handle—or avoid—prior authorizations electronically, the Network Alliance is helping head off nonadherence before it starts.
Eligibility & Formulary
Eligibility & Formulary gives clinicians insight into patients’ prescription benefit coverage at the group or plan level, setting the stage for success across many solutions. In 2022, Eligibility informed 4.34 billion care events.
On-Demand Formulary delivers plan-level formulary information to prescribers via an instantaneous request and response transaction—replacing large formulary file downloads for greater efficiency and accuracy. In 2022, the number of healthcare professionals using On-Demand Formulary increased by nearly 13%.
Real-Time Prescription Benefit
Real-Time Prescription Benefit sends cost and coverage information directly from the prescription benefit plan, including prior authorization flags, days’ supply options and up to five covered therapeutic alternatives that may cost less or avoid prior authorization. In 2022, more than half of prescribers on the Surescripts network used it to access medication pricing.
99% of insured U.S. patients covered by data supplied directly by pharmacy benefit managers and health plans
98% of U.S. prescribers served by contracted EHRS
$61.17 average savings per prescription
when used to find a less costly alternative (+67% in 2022)
Electronic Prior Authorization
If a prescriber chooses a medication that requires prior authorization, Electronic Prior Authorization can get the prescription filled more quickly and efficiently by delivering prior authorization insights, dynamic question sets and responses.
99% of insured U.S. patients covered by contracted pharmacy benefit managers and health plans
84% of U.S. prescribers served by contracted EHRs 44% more authorizations processed electronically in 2022
27% increase in daily average number of prescribers using Electronic Prior Authorization in Q4 2022, compared to Q4 2021
3 minutes, 54 seconds to receive an answer on average
(13 seconds faster than in 2021)
Health Plans pursue positive outcomes with Clinical Direct Messaging
Four health plans and two pharmacy benefit managers covering nearly 220 million patients nationwide used Clinical Direct Messaging in 2022 to pursue goals including:
Pickup rate:
3.2 percentage points higher2
Out-of-pocket costs:
11% lower overall and 40% lower for high-cost drug classes3
Fill rate:
8.1 percentage points higher4
Cancellation rate:
5.5 percentage points lower5
Prescription optimization:
days’ supply adjusted in 44% of medication orders and quantity adjusted in 69% of orders6
The 2022 National Progress Report
Footnotes:
- Alex Montero et al., “Americans’ Challenges with Health Care Costs,” KFF.org, July 14, 2022.
- Surescripts, “2022 Medication Affordability & Adherence Impact Report,” September 2022.
- Sunita M. Desai et al., “Effects of Real-Time Prescription Benefit Recommendations on Patient Out-of-Pocket Costs,” JAMA Internal Medicine 182 (11): September 12, 2022.
- Shiven Bhardwaj et al., “Impact of Real-Time Benefit Tools on Patients’ Access to Medications: A Retrospective Cohort Study,” The American Journal of Medicine 135 (11): July 23, 2022.
- Shiven Bhardwaj et al., “Impact of Real-Time Benefit Tools on Patients’ Access to Medications: A Retrospective Cohort Study.”
- Shiven Bhardwaj et al., “Implementation and Cost Validation of a Real-Time Benefit Tool,” The American Journal of Managed Care 28 (10): October 2022.
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