Jan 21, 2021

Sticker Shock at the Pharmacy Isn’t Healthy

Helen Farnen   |   Updated December 15   |  Reading time: 2 minutes


Raise your hand if you’ve heard this story before. A physician writes a prescription for a patient, but during a follow-up visit two weeks later, the prescribing doctor discovers that the patient isn’t taking their medication. After a little probing, the doctor learns that the out-of-pocket cost was more than the patient could afford, or that the patient’s insurance company didn’t cover the medication. It’s no surprise that the patient’s condition is not improving.

Prescription abandonment was as high as 30% in 2017, with more than 67% of patients who did not fill a prescription saying that high costs were the reason, according to a Truven Health Analytics-NPR Health Poll. A study conducted by West Health-Gallup reported that cost was the reason why 15 million Americans did not purchase prescriptions in 2018.

And the impact of non-adherence or not taking prescribed medications can be staggering. A National Institutes of Health report estimates that 125,000 preventable deaths are the result of non-adherence. The same report calculates the total cost of medication non-adherence ranges from $100 billion to $300 billion every year. The direct cost to patients can be significant too. Patients with chronic disease, such as hypertension or diabetes, can save between $4,000-$8,000 per year by taking medicines as prescribed due to reduced complications, hospital administrations, and lost time away from work.

Technology to the rescue

Today’s healthcare consumers and their providers are more comfortable with discussing treatment and its cost, which is an important step in the right direction. But often physicians can’t keep up with constantly changing information about medication costs, formularies, and what’s covered by a patient’s insurance.

Fortunately, many standalone electronic prescribing and eRx-enabled electronic health records (EHRs, sometimes known as EMRs) systems feature pricing tools. During a patient encounter, prescribers can provide real-time cost information, which enables prescribers and patients alike to discuss alternative medications that may be less costly.

Here’s the downside: not all e-prescribing and EHR systems offer pricing functionality. And for those that do, there are limitations-not all insurers, drugmakers, and pharmacy benefit managers make this information available to providers. But there is good news: there is a national push for more drug cost transparency. And starting on January 1, 2021, the Centers for Medicare and Medicaid Services requires all providers who accept Medicare drug coverage (Medicare Part D) to use an e-prescribing system with a pricing tool. This means doctors and patients can better evaluate prescription costs, saving both time and money.

Real-Time Pricing Transparency

RXNT supports price transparency for your patients via our Real-Time Prescription Benefit feature within our Electronic Prescribing software. You and your patient can review what the patient will pay based on quantity and where the prescription is dispensed (retail or mail order). It also provides comparison information for alternative medications so that you and your patient can make treatment decisions for the best health and financial outcomes. See how it works with a quick, no-obligation demonstration from one of our dedicated customer advisors. Schedule a demo here.
Interested in learning more about helping patients afford care? Read the article: Struggling to Collect Payments From Patients? Try More Flexible Payments.

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