Price Transparency as a Health Intervention — Our Efforts to Improve Health and Save Patients’ Money
Prescription drug costs represents a sizable amount of spending for US healthcare consumers, and the cost of medications can force patients to have to make difficult choices. Some quick stats:
- Prescription drugs currently account for around 10% of total healthcare spend (this was approximately $333,000,000,000 in 2017)
- Studies show that 20–30% of prescriptions are never filled, and half of medications for chronic conditions aren’t taken as prescribed
- One out of four adults who take medicine note that it is difficult to afford their prescription medication. High co-pays are tied to increased abandonment of prescriptions
- A third of patients look at price when filling medications, mostly driven by millennials
- In the same poll, among those who did not fill their prescription, cost was the top reason (67%) for not doing so
- Removing cost as a barrier, as done in a recent clinical trial, improved patient follow-through with medications, and improved blood pressure control
All told, this represents an important area for innovation to help patients afford and take medications when necessary.
The cost of medications also impacts clinicians too, tying up time and resources on prior authorizations or downstream calls with pharmacies and patients looking for alternatives.
Transparency around cost is needed at the point of prescribing to help with decision-making around medications. Transparency can provide information about the actual cost of a medication, and what a patient will be expected to pay. Currently, clinicians have little insight into what medications will actually cost for patients when an e-prescription is sent.
To provide more transparency on pricing, and to enable conversations between patients and their clinicians at the point of prescribing, we are rolling out new tools this month at Froedtert & the Medical College of Wisconsin.
We have partnered with 3 key companies — RxRevu, SureScripts, and Epic — to enable real-time checking of patients’ eligibility for pharmacy benefits from insurance, providing to patients and clinicians the actual out of pocket cost that patients would pay that day for their medicine. We have also configured decision support to alert clinicians if patients would have a less expensive medication alternative. These alerts will work in our scheduled office visits, as well as in the emergency department and for hospital discharge medications. This new functionality will give providers greater insight into out of pocket costs for patients, as well as prompt alternatives that may be clinically appropriate and covered by the patient’s insurance for a lower cost.
Including out of pocket cost for the patient in the conversation between clinicians and patient on benefits and risks of each medication allows for a timely and more open dialogue, hopefully setting the patient up for better achievement of outcomes and follow-through.
Giving clinicians and patients more information about the cost of medications, and the actual cost the patient will be faced with at the pharmacy, along with any suggested alternatives covered by their prescription insurance coverage, can help the clinician and patient make better decisions and cut down on unnecessary expenses.
Having this information up front about the cost and any alternatives of medications can circumvent the frustrating process of the patient getting to their pharmacy and being told something is not covered or requires a prior authorization. Including out of pocket cost for the patient in the conversation between provider and patient on benefits and risks of each medication allows for a more open dialogue, hopefully setting the patient up for better achievement of outcomes and follow-through.
We’ll still need to continue to work on finding ways to cut down on patient out of pocket costs. We are looking at how we can more seamlessly look at cash payments for medications (rather than through insurance) as a way to reduce patients’ costs for medicines. GoodRx, a company that facilitates cash-based price transparency and provides coupons for prescription medications, claims to have saved Americans $10 billion on prescription drugs since they started in 2011, and $5 billion within the last year alone. Notably, 70% of those patients also had insurance coverage. Other consumer companies have also been working on cash-based options for many medications for chronic conditions, including Walmart’s $4-prescription program.
Overall, this represents a big step forward to being able to help our patients save money, and in turn improve their ability to follow through with care plans. We already are showing prices for common procedures on froedtert.com, and are moving that also toward real-time checking with Epic and our patient portal. More to come.
