2018 Real-Time Benefit Check National Adoption Scorecard Key Findings

August 20, 2018  |  Jessica Behrendsen

A provider with a family

Working closely with an expert panel of advisory board members representing various industry stakeholders, from the American Medical Association (AMA) to Humana and Best Rx, CoverMyMeds has released the first go-to source of information for real-time benefit check (RTBC).

The purpose of this report is to highlight new data revealing patient and provider success factors for RTBC, implementation models and the status of RTBC adoption by electronic health record (EHR) systems. Specific information related to these factors is critical to the adoption and success of RTBC, based on provider and patient feedback. Various implementation models exist and are being developed in the industry, and it’s important for stakeholders to educate themselves on the benefits of each.

The report is designed to navigate easily to sections of interest depending on the reader's network, beginning with an overview of RTBC and ending with current availability of the solution in the industry.

Read on for key elements that could be relevant to your place in the industry, and visit the scorecard for more information.

Key Industry Findings

Providers

Providers cite cash price, co-pay information, alternative options, PA requirements and patient assistance program availability as essential functionality for an RTBC solution that facilitates better patient care.2 With an integrated RTBC solution, providers are better equipped to answer questions patients have about the cost of their prescription without the disruption of leaving their EHR. With insight into true price transparency, providers are better prepared to make prescribing decisions alongside patients, strengthening the quality of their relationship.

2

86% of providers surveyed stated that a reliable RTBC solution would benefit their patients and assist in making more informed decisions when it comes to treatment.1

EHRs

When providers don’t trust their system of formulary and benefit information, they are less likely to have conversations with their patients about whether they can afford a prescribed medication, which means patients often learn about the cost of their medication too late. EHR systems that provide true cost transparency at the point of prescribing surface better quality data that providers can trust, allowing important conversations about precise pay amounts to happen with patients at the point of prescribing.

3

Providers who currently have access to formulary information in their EHR have an average trust rating of only 5.7/10.2

Pharmaceutical Manufacturers

Patients are already seeking ways to improve their access to medication, such as checking manufacturer portals for coupons or assistance with the PA process. Patient assistance programs can reduce out-of-pocket costs, which can impact the likelihood that a patient will initiate and adhere to their prescribed medication. Effective RTBC solutions help pharmaceutical manufacturers increase awareness of the availability of programs that help patients evaluate and expand options for the prescriptions they can afford. This connects patients to the information they’re already looking for earlier in the prescribing process, saving them valuable time and helping them stay on the medication their provider believes will produce the best outcomes.

4

42% of patients with a high-deductible plan have used or tried price-shopping platforms to research discounts.1

Payers

Patients who are enrolled in high-deductible plans are more likely to pay more out of pocket for their medication, with 46 percent of patients reporting that the cost of their medication is a burden.4 With high-deductible plans on the rise, there is an increased need for prescription price transparency within the provider’s office to help reduce the rate at which prescriptions are abandoned at the pharmacy. Payers can assist their members by equipping providers with insight into the most cost-effective and clinically appropriate medication options. When participating in RTBC, payers can inform providers of patient-specific benefits that dictate co-pay, and can surface formulary alternatives while increasing efficiency in clinical review when prior authorization (PA) is required. 

The percentage of adults enrolled in a high-deductible plan increased from 25.5% in 2011 to 43.2% in 2017.3

5

Pharmacies

Patients who arrive at the pharmacy and are aware of cost implications for their treatment are more likely to leave with their prescribed medication. This means the pharmacy can fill more prescriptions and avoid restocking fees, and pharmacists and technicians would no longer be doing the heavy lifting of providing patients with medication cost and cost assistance information. With this barrier lifted, pharmacists can focus on counselling patients on how to appropriately take their medication.

6

Half of all patients surveyed say they did not fill a prescription because it cost too much when they arrived at the pharmacy.1

Interested in learning more? Read the full 2018 Real-Time Benefit Check National Adoption Scorecard.

  1. CoverMyMeds Patient/Provider Research, 2018
  2. CoverMyMeds Patient/Provider Research, 2018
  3. Centers for Disease Control and Prevention
  4. CoverMyMeds Patient/Provider Research, 2018
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