How Real-Time Prescription Benefit EHR Integrations Drive Price Transparency

With just a few clicks of a button, Dr. Kevin Maben was able to make a $500 prescription become a zero-dollar one, a feat possible thanks to real-time prescription benefit EHR integrations.

Ensuring a patient can afford their prescription is key to medication adherence. A 2021 report from the Robert Wood Johnson Foundation and Urban Institute found that 13 million adults did not fill a prescription or delayed filling a prescription because of high cost. 

“Just like I don't want to write something a patient is allergic to, I don't want to write them a medication that they can't afford,” Kevin Maben, MD, FAAP Pediatrics, a pediatrician and clinical informaticist at Presbyterian Healthcare told EHRIntelligence in an interview.

“We know cost is one of the big barriers to adherence,” he added. “People either don't fill their prescription because they can't afford it, or they try to stretch it out and don't take the right dose which really impacts their outcomes and their health.”

Understanding the actual out-of-pocket drug cost is integral to clinical outcomes, but constantly changing pharmacy benefits makes keeping track of prescription costs challenging.

“When you think about pharmacy coverage, it's really challenging,” Maben said. “Some people have a high deductible plan so their copay and co-insurances change over the year. Medicare patients have that donut that they hit, and their costs go up. It's hard to keep track of all that stuff.”

To drive price transparency, Presbyterian Healthcare tapped real-time prescription benefit technology (RTPB) to provide patients with medication pricing during their visits. With RTPB technology, Maben can provide accurate medication pricing information at the point of care and help each patient find affordable treatment options.

“My families really like seeing that price information before they go to the pharmacy,” Maben said. “Parents will even ask me if I can hit that button so they can see what to expect when they get to the pharmacy. I think it’s pretty cool to give them that control for making these types of decisions.”

Integrating RTPB into the EHR has not only helped patients save money, Maben said. It has also helped Presbyterian support patient empowerment.

By going through all the available options for prescriptions, providers can work with patients to find the medicine that’s the best fit for them. For instance, while a medication may be more expensive, it may be a patient’s preferred option because it has few side effects.

“Patients are able to make that informed decision on what's right for them instead of me telling them I want them to take this medicine,” Maben said.

He noted that RTPB is an evolving piece of clinical decision support, similar to EHR alerts that warn providers of patient medication allergies.

Maben also said that the tool can help providers avoid prescribing medications that require prior authorizations.

“While a medication may require a prior authorization, another medication in the same class may not require one,” Maben explained. “Writing something that doesn't need a PA saves everyone's time and money and it has real benefits to people.”

He said that the technology from health IT vendor Arrive Health (formerly RXRevu) presents RTPB information to providers in two ways.

First, providers can proactively hit an “estimate” button to bring up costs.

Additionally, when the provider orders a prescription, the tool automatically sends a test claim out. If there is a lower-cost alternative that the pharmacy benefit manager has billed out, the provider will get a popup window where they can switch to the less expensive option with a single click.

The technology has helped save Presbyterian Healthcare patients significant amounts of money on medications.

For example, a nurse practitioner in Maben’s office wrote a patient a prescription for asthma control medicine. When the patient’s parent went to pick up the medication at the pharmacy, she learned it would cost her $500.

The parent went back to the office and requested the provider prescribe something else. Maben overheard the nurse practitioner writing another prescription and reminded her about the RTPB technology.  

“We went in and put in different options in that same class,” he said. “We used the estimate button in Epic that lets us put in that test claim and shows us all the different cost classes.”

The medicine that the nurse practitioner was planning on writing was $75, which Maben said is still expensive for a chronic med. But low and behold, the providers saw that there was an option that had a zero-dollar copay.

“We were able to take this family from $500 to zero,” he said. “The mom was in tears, and that, to me, is the power of this technology.”

Maben said that this isn’t the only time the technology has eliminated a patient’s prescription costs altogether.

“I had another asthmatic patient who was being managed by an outside specialist,” he said. “The mom shared that she was frustrated because the medication that the specialist wrote was $250 every time that they got it filled.”

After entering different options into the RTPB, Maben found a medication with no copay.

Maben said that after almost four years of using RTPB, Presbyterian Healthcare has found significant value in the technology.

“I can't overstate how important it is being able to have accurate, clear information around costs right at the time that I'm delivering care for a patient,” he noted. “It certainly saves the patient money. It saves the health delivery system. It saves the payers.”

“We use the word transformation a lot these days, but I would argue that this type of tool is transformational in that we can have this type of information at our fingertips right when we're delivering care to patients to make the best decision for them,” Maben said.