Patient Visibility into Out-of-Pocket Prescription Costs Takes on Added Importance in January

Blog Posts - 11 January 2019


In January 2019, healthcare providers are rapidly adopting new technologies to help them to meet this growing demand with patient-specific cash pricing, formulary information, generic and therapeutic alternatives and patient financial assistance programs appearing directly within their existing electronic prescribing workflow. Prescription Price Transparency, from Veradigm™, has seen prescribers generate more than 15 million price transparency transactions covering 1.6 million patients in the U.S. since March 2018.

With the new year comes new patient insurance, new deductibles, and other information, all of which can be seamlessly integrated into a provider’s clinical workflow through price transparency e-prescribing solutions. The influence of these and other “new plan year factors” impacting medication price transparency, and the value to be derived from it, is the stimulus for this article.

January 2019 is an Especially Difficult Month for Providers to be Without Price Transparency
With price transparency solutions readily available (often at little or no additional cost to providers), practices that lack access to this information within their clinical workflow are at a disadvantage. This situation is exacerbated further every January, when patients begin a new year of insurance coverage that frequently includes changes to their insurance carrier, insurance plan, and/or formulary, as well as the resetting of deductibles.

Many price transparency solutions only deliver information to providers on the cash (non-insurance) pricing for the prescribed drug, and potentially generic alternatives as well. To provide a complete picture of their OOP cost alternatives, providers must also have access to real-time, patient-specific benefit, formulary and insurance data. The more complete and real-time the data, the better equipped providers are to help talk their patients through their actual OOP costs, regardless of changes for the new year.

New Year’s Coverage Changes Obscure Out-of-Pocket Costs for Patients
January is a busy time of year. Patients are returning from the holidays and hitting the new year running at work or with their families - how many are taking the time to think through how their prescription drug benefits have changed?

If a doctor does not have access to both cash pricing and real-time benefit information specific to the patient, that patient could easily find themselves in sticker shock when they learn the cost of their medications – especially in January. Instead of having an informed conversation during their physician appointment, the patient instead is calling the doctor’s office to discuss alternatives while still in the pharmacy, all with the possibility that whatever therapy they decide upon might be available for a lower price at a different pharmacy.

Price Transparency Impacting How BioPharma Companies Support Medication Adherence
As provider adoption of price transparency solutions grows, and especially as this trend is accelerated further by the New Year factors already discussed, patients will be working with their doctors to make faster and more frequent changes to therapy. Resulting data about which patients and providers are making changes to therapy regimens will propagate through the healthcare system faster than ever before.

For BioPharma companies, that means enhanced opportunities to identify changes in behavior sooner. Making the most of these opportunities requires a partner who can not only help quickly identify changes in therapy but provide the means to effectively act on that insight through both proactive and workflow-triggered communication channels directly into the provider’s practice and clinical workflow.

Veradigm– Transforming Health, Insightfully

As more and more providers signing on to use price transparency solutions every day, and the effect of another New Year likely to accelerate adoption even further, now is the time for BioPharma companies to be putting plans in place to meet the challenges associated with price transparency. And it is essential to do so in a way that enables them to optimize medication adherence and quality of care while driving improved access.

Combining a comprehensive Prescription Price Transparency solution accessible by more than 100,000 HCPs, hundreds of data sharing and integration industry partnerships, and a legacy of more than 20 years in electronic point-of-care prescribing, only Veradigm delivers the unique combination of experience, expertise, and straightforward usability BioPharma companies - and the providers and patients they serve - need to succeed in the age of price transparency.

For more information on how Veradigm Media Solutions for e-prescribing and electronic health records can help you effectively manage the impact of price transparency, please contact us.