Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

Practice Management News

Providers Seek Prescription Price Transparency, Patient Cost Data

The majority of providers in a recent survey want to increase prescription price transparency, but manual processes are impeding improvements.

Prescription price transparency and patient cost data

Source: Thinkstock

By Jacqueline LaPointe

- Providers want to boost prescription price transparency to lower costs and improve care quality, a new survey of over 500 healthcare professionals uncovered.

The Engine Group and Surescripts survey showed that 78 percent of professionals think it is very important to have access to information on patient out-of-pocket costs. Another 69 percent also believed access to information on lower-cost therapeutic alternatives was very important.

The survey results illustrate the push for increased prescription price transparency, researchers explained. With prescription drug spending rising, providers want more access to patient-specific information at the point of care to ensure high-quality care for their patients.

Prescription drug spending is slated to grow faster than any other major healthcare sector, the CMS Office of the Actuary recently reported. Actuaries project drug spending to increase by 6.3 percent between 2017 and 2026 largely because of faster projected drug price growth.

Prescription drug spending growth spells trouble for patients whose individual drug spending already accounts for 17 percent of all spending on personal healthcare services.

Rising drug costs could also result in worse care quality and patient safety. For example, increased costs negatively impact medication adherence. An analysis showed a $10 copay boost increased the likelihood of prescription abandonment by 10 percent.

More recently researchers from Consumer Reports Best Buy Drugs found that 14 percent of patients do not fill their prescriptions because of medication costs. And going forward, 24 percent of patients said they were not confident that they will be able to afford their medications.

Providers are pushing for increased prescription price transparency to ensure patients take their medications, as well as remain financially healthy.

However, the majority of healthcare professionals do not have sufficient access to the data they need to manage drug spending. Eighty-seven percent of respondents of the Engine Group and Surescripts survey said understanding prescription costs for patients is a significant or moderate challenge.

“Traditional prescribing is plagued by information gaps and unwelcome surprises that can delay—or completely derail—the patient’s treatment,” the report stated. “Rising drug costs, the burden of manual prior authorization and lack of insight on therapeutic alternatives present a major challenge. Patient-specific information at the point of care can meet this challenge—if clinicians have access to it.”

Providers do have access to some electronic prescribing tools. The survey revealed that 88 percent of professionals have the ability to use e-prescribing systems at their organization.

However, other key components of the prescribing cycle are not automated. Less than one-quarter of respondents (23 percent) said they have access to electronic prior authorization, and just 14 percent reported having access to prescription pricing information in the EHR system.

Prior authorization automation is particularly lagging across the industry. The most recent CAQH Index showed adoption of fully electronic prior authorizations reached just 12 percent in 2018, while the proportion of manual prior authorizations increased from 35 to 51 percent compared to the previous year.

In contrast, electronic workflows for three of the seven claims management transactions analyzed were at or above 80 percent in 2018.

Failing to automate the prescribing workflow significantly increases administrative burdens for healthcare professionals. The 2018 AMA Prior Authorization (PA) Physician Survey found 65 percent of providers are waiting at least one business day for prior authorization decisions, and 26 percent report waiting at least three business days.

Additionally, healthcare professionals are spending more time on non-clinical and administrative tasks without patient-specific information at the point-of-care, the Engine Group and Surescripts survey showed. On average, providers are spending:

  • 2 hours per week consulting with patient on prescription costs
  • 1.7 hours per week obtaining prior authorizations for specialty medications
  • 1.1 hours per week acquiring information on lower cost therapeutic alternatives
  • 1 hour per week understanding medication pricing for patients

Issues related to prior authorizations are resulting in patients forgoing treatment, the AMA added. Three-quarters of respondents said prior authorization troubles always, often, or sometimes lead to treatment abandonment.

To reduce prescription drug spending and improve care quality, providers need technology that can increase prescription price transparency and put patient-specific data into prescribing workflows in the EHR systems, researchers stated.

“Tools that enable prescription price transparency and automated prior authorization will continue to make a measurable impact on clinicians and their patients,” the report concluded. “Our industry is on the right path. But there’s more work to do.”

“To realize the full potential of prescription price transparency, we must continue working to connect EHRs, clinicians and patients nationwide. Patients expect (and deserve) high quality and affordable care. Clinicians expect quick and easy access to patient information.”


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