Prescription Price Transparency

Prescription Price Transparency

Prescription pricing in the United States varies greatly and is extraordinarily difficult to predict. One thing we all understand, however, is that prescription drugs can be costly. The average American spends around $1,200/year on medications.¹ The ability for families to afford health care has increased from an area of high concern in the 1990s to an area of extreme anxiety for millions of Americans today. According to Gallup, when surveyed, 27% of individuals in the U.S. identified either healthcare or medication affordability as the country’s “most urgent health problem.”²

Part of the anxiety associated with medication affordability stems from the unpredictable nature of insurance reimbursement for prescriptions. Unlike many consumer goods, the out-of-pocket costs patients pay for their prescriptions can vary significantly and often depends upon insurance coverage, where they live, which pharmacy they visit, and whether they have any coupons or discounts available to them.

Addressing medication affordability through prescription price transparency is a key focus area for Veradigm. We’ve compiled this guide to prescription price transparency with links to related blog articles, reports, videos, and more.

Why Prescription Drug Price Transparency Matters

Prescription drug price transparency matters because many patients live on a budget, and factoring in the cost of medications is critical. Research shows that 42% of Americans have reported they are struggling to pay for their prescribed medications.³

Unfortunately, prescription drug pricing can be complicated and the prices themselves are variable. Patients, therefore, are often left in the dark about how much their medication will cost when they arrive at the pharmacy.

Healthcare providers are also typically unaware of the cost associated with the medications they prescribe. If clinicians are empowered to have a conversation about the cost of prescriptions at the point-of-care, they can work together with patients to choose the most cost-effective, clinically appropriate option for their treatment.

Patients are Consumers Too

Patients are empowering themselves to play a more active role in the management of their health. With the rise of e-commerce and online price comparison tools, we all have become accustomed to being able to compare prices when shopping. Why should prescription medications be any different?

Physicians are trained to prescribe medications based upon a variety of factors other than affordability. Medications are selected based upon clinical guideline recommendations, patients’ diagnoses and co-morbidities, drug interactions, tolerability, and other clinical factors. By recognizing that patients are consumers too, prescribers can begin to leverage price transparency tools to have a cost conversation with their patients at the point of care.

Trust Through Transparency

Having a transparent price conversation at the point-of-care can increase trust between clinicians and their patients. Knowing how much a prescribed medication will cost reduces sticker-shock when patients arrive at the pharmacy to pick up their prescription. No one likes to be surprised with a big bill they were not expecting, especially when it has to do with something as important as healthcare.

If a patient and prescriber select medications together, while incorporating price into the conversation, a level of trust is established between the two parties. When a patient arrives at the pharmacy to pick up the selected medications, and there are no surprises when it comes to cost, that trust is reinforced.

Medication Adherence

Perhaps the most important reason why prescription drug price transparency matters is medication adherence. Medications can only improve health outcomes if patients take them as directed. Patients can only take their medications as directed if they can afford them.

Research shows that higher out-of-pocket costs for prescription medications correlate with increased prescription abandonment. In fact, 33% of patients have purposely failed to fill a prescription due to prohibitive cost. What’s more, nearly 6% of patients have skipped doses of their medications three times or more to save on drug costs.³

Having the Pricing Discussion at the Point-of-Care

While many prescribers are aware that discussing price with their patients is an option, initiating the conversation can be difficult. A survey conducted by Veradigm in 2019 found that some physician respondents reported that they did not view the medication cost conversation as their responsibility. Others said that while they understood that patients valued the conversation, they did not feel comfortable or equipped to have it.⁴

The tendency to shy away from a potentially uncomfortable conversation about financial matters is understandable. With easy-to-use technology integrated into a prescriber’s workflow, however, it requires little to no additional effort to access patient-specific prescription medication pricing at the point-of-care. In fact, failing to discuss prescription pricing with patients represents a missed opportunity to improve standards of care.

While it may seem daunting at first, discussing medication affordability relevant to patient care quickly becomes easier with experience. And with technology at prescribers’ fingertips, clinicians can initiate the conversation by simply showing their patient a screen with available options.

How Can Patients Save Money on Prescription Drugs?

Patients can save money on prescription drugs in a variety of ways. Prescription drug pricing is highly variable depending on a patient’s insurance, their geography, if a generic version of the medication is available, which pharmacy they select to fill their prescriptions, or if they make use of price comparison tools like GoodRx®.

One extraordinarily powerful way for prescribers to help patients save money on prescription drugs is to use a prescription price transparency tool integrated directly into their electronic health record.

In the next section, learn about how Veradigm RxTruePrice™ is helping patients save money on prescription drugs.

Prescription Price Transparency and Veradigm RxTruePrice

Veradigm RxTruePrice empowers prescribers to enhance medication affordability for patients with a prescription price transparency solution integrated directly into the e-prescribing workflow. This powerful solution from Veradigm simplifies electronic data exchange on medication cash price, benefit coverage, potential alternate therapies, mail order options, prior authorization requirements, quantity or days’ supply coverage limitations, and more.

RxTruePrice helps to identify appropriate cost-saving opportunities, reduce medication wait time, and decrease the interruptions in patient care that can occur between the physician’s office and picking up or receiving prescribed medications. RxTruePrice also reduces rework for the healthcare provider and staff and can eliminate unnecessary calls from pharmacies due to challenges with affordability.

In 2019, Veradigm surveyed users of RxTruePrice. The results demonstrated that RxTruePrice is helping healthcare providers positively drive improvement for patients.