Veradigm RxTruePrice™ Empowers Providers with Prescription Cost Savings Insights at the Point of Care
Written by: Jill Helm and Cheryl Reifsnyder, PhD
In recent years, patients have been incurring an increasingly higher share of their healthcare costs. At the same time, costs for prescription medications have skyrocketed. The Centers for Medicare and Medicaid Services (CMS) estimates that, between 2012 and 2016, prescription drug spending increased 26.8%. A PEW study of the same period found that net spending on prescription medications rose from $250.7 billion in 2012 to $341.0 billion in 2016—a 36% increase.
The U.S. Department of Health and Human Services (HHS) tracked price changes for individual prescription medications and found:
- From 2021 to 2022, 1,216 medications had price increases greater than the inflation rate for that period (8.5%), with an average price increase of 31.6%.
- 15% to 18% of these price changes were “significant increases”, where “significant” included any price increases that were either a) greater than $20 and at least a 10% increase during a 12-month period or b) any price change greater than $500.
- Some drugs increased by more than $20,000, or 500%.
With Americans forced to spend more on prescription medications than anywhere else in the world, prescription pricing information is becoming an essential piece of patients’ treatment plans. Veradigm’s RxTruePrice™ is a prescription price transparency solution that empowers prescribers to provide their patients with information to enhance medication affordability and more. Keep reading to learn how.
Patients shoulder the burden of rising prescription prices
These rising prescription prices are negatively impacting patients on multiple levels. Recent studies show that 42% of Americans struggle to pay for their medication—even though 94% of those individuals had some form of insurance. A Wolters Kluwer 2022 U.S. Consumer survey reported that rising drug prices are pushing people to “forgo needed care, groceries, even rent”.
On top of that, the root of patients’ failure to adhere to their prescribed medication care plan is often related to an inability to afford the medication. In a KFF 2022 national opinion poll, surveying adults of all ages, 31% of respondents reported not taking medications as prescribed due to high costs at some point in the past year; a similar survey, published May 2023 in the JAMA Network Open, focused on adults age 65 and older and found that 20.2% reported cost-related medication nonadherence. A study from Truven Health Analytics-NPR showed that high prescription drug costs were the cause of 67% of patients’ medication non-adherence. They also found:
- 94% of patients with annual incomes less than $25,000 reported failure to fill or pick up their prescriptions due to cost.
- More than 12% of patients said high costs caused them to stop taking their medication before their provider recommended stopping treatment.
For some patients, the consequences are exceptionally difficult. Although efforts are currently underway to address the insulin cost crisis, a 2022 study from CharityRx reported that 79% of U.S. adults who have diabetes, or care for someone with diabetes, said that paying for insulin had caused them financial difficulty:
- 4 of 5 people surveyed reported taking on credit card debt to cover their medication costs, with an average credit card debt of $9,000.
- 62% reported skipping and/or adjusting their insulin dosage to save money.
- Of those who reported insulin rationing:
- 54% reported being unable to perform everyday activities.
- 33% reported becoming sick as a result.
- 38% reported spending 1 or more days in the hospital.
High prescription prices, and patients’ difficulties dealing with them, clearly interfere with patient care.
Veradigm RxTruePrice: the value of prescription price transparency
Veradigm RxTruePrice gives providers a unique tool for improving patient medication adherence by providing prescription price transparency at the point of care.
When patients fail to adhere to their medication treatment plans, there are usually several influencing factors:
- They are incurring a higher share of healthcare costs.
- They feel overwhelmed by the complexity of their own pharmacy benefit.
- They fail to understand the prescribing process and how they might minimize their costs.
- They underestimate the negative effects of non-adherence.
Dr. Andrew Mellin, Chief Medical Information Officer at Surescripts, a leading service provider in helping Veradigm to provide physicians with prescription price transparency information, says, “Medications have become expensive and when you’re at your provider now, they need to have a cost conversation, make sure it’s affordable to you or find lower cost alternatives.”
Veradigm RxTruePrice makes this conversation possible by making prescription price information easy to access. We accomplish this by working with drug price comparison platforms, health plans, pharmacy benefit managers (PBMs), and others to deliver real-time price and benefit information at the point of prescription. This solution enables providers to obtain information on:
- Discounted health plan or PBM pricing
- Cash pricing
- Available therapeutic alternatives
- Competitive prices at local and mail-order pharmacies
All prescription pricing and benefit information is patient-specific, and all information is accessible within the current ePrescribing workflow.
Veradigm RxTruePrice, and the information it provides during the prescribing workflow, enables providers to enhance medication affordability for their patients. RxTruePrice simplifies electronic data exchange, helping identify appropriate cost-saving opportunities, reduce medication wait time, and decrease the care interruptions that can occur between the patient’s office visit and picking up or receiving their prescription.
A review of RxTruePrice transactions from January 2023 through April 2023 (see Table 1) showed that providers using Veradigm RxTruePrice were able to help their patients achieve an average cost savings of $42.08 per prescription. The average monthly total patient cost savings for this period was $146,355.1-4
Table 1: Veradigm RxTruePrice Savings Highlights (January through April, 2023)
| Jan-20231 | Feb-20232 | Mar-20233 | Apr-20234 | Monthly Average | |
|---|---|---|---|---|---|
| Real-Time Prescription Benefit Requests | 2,293,997 | 2,141,496 | 2,444,776 | 2,088,239 | 2,242,127 |
| PBM* Responses with Lower Cost Alternative | 37.28% | 36.56% | 35.95% | 34.97% | 36.19% |
| Average Prescription Cost Difference | $48.20 | $38.18 | $47.64 | $34.29 | $42.08 |
| Total Patient Savings | $183,067 | $105,246 | $172,136 | $124,972 | $146,355 |
*PBM: Pharmacy Benefit Managers
As Dr. Mellin noted, “Those patients, when they show up at the pharmacy, they’re not being surprised. They’re not having that sticker shock because they’ve had that conversation and they know what it’s going to cost.”
Help your patients afford their medications
Veradigm RxTruePrice can help the 42% of Americans who report struggling to pay for their medications by giving them a clearer view into their medication pricing and price savings alternatives—before they leave their provider’s office. When patients know the cost of their medications at the point of care, getting them to stay on their prescribed treatment plan becomes easier. Helping your patients with medication costs can help improve patient outcomes.
In 2018, Veradigm RxTruePrice was used by more than 20,000 healthcare providers to process nearly 17 million transactions for more than 1.7 million patients—and adoption has continued to increase. This tool could help you open critical cost conversations with your patients as well.5
If you’re a current Veradigm client, Veradigm RxTruePrice is most likely already available within your existing clinical workflow, at no additional cost. To learn more about Veradigm RxTruePrice, or to ensure successful enablement of this feature, contact your Veradigm representative.
Not yet a Veradigm client? Contact us to schedule a demo today!
References:
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Surescripts. Veradigm January 2023 Real-Time Prescription Benefit Report Card. January 2023.
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Surescripts. Veradigm February 2023 Real-Time Prescription Benefit Report Card. February 2023.
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Surescripts. Veradigm March 2023 Real-Time Prescription Benefit Report Card. March 2023.
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Surescripts. Veradigm April 2023 Real-Time Prescription Benefit Report Card. April 2023.
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Veradigm data on file. December 2018.