Once integrated with the EHR, the solution will also display therapeutic alternatives.
In an effort to prevent prescription sticker shock and abandonment, Surescripts is teaming with major EHR companies, CVS Health, and Express Scripts to provide patient-specific benefit and price information to providers in real time at the point of care.
Practice Fusion, Allscripts, Aprima Medical Software, Cerner, Epic, and GE Healthcare will offer the tools to their users, who represent more than half of US physicians. Surescripts will use information from PBMs CVS Health and Express, which represent nearly two-thirds of U.S. patients.
“Surescripts already gives prescribers access to a patient’s group level formulary and benefit information within the EHR workflow during the e-prescribing process,” Surescripts CEO Tom Skelton told HealthLeaders Media via email.
“But now, we’re able to deliver real-time price information based on their patient’s specific co-pays, co-insurance, benefit counters, on/off formulary requirements and caps on out-of-pocket payments, along with therapeutic alternatives, benefits barriers, and whether the medication is a specialty drug that requires additional processing,” he said.
Prescribers will be able to see what a medication will cost their patient based on the patient's health plan coverage and pick the most affordable medication that meets the patient's therapeutic need.
Once integrated with the EHR, the solution will also display therapeutic alternatives so the prescriber and patient can choose a medication that’s both clinically appropriate and affordable.
“With our price transparency tool, patient-specific benefit information is provided through the prescriber’s existing EHR, so the workflow is the same,” Skelton said when asked whether the tool would change the way prescribers interact with the EHR.
Once a medication is selected, if an authorization is required, it can be completed quickly during the office visit within the EHR workflow. The authorization is then sent to the pharmacy.
“This ensures the patient leaves the office confident in the medication choice, the cost, and the fact that it will be covered by their PBM or health plan,” Skelton said. “Not only can this help improve medication adherence, but it will also reduce the inefficient and manual back and forth that often occurs between prescribers, pharmacists, PBMs and patients.”
Alexandra Wilson Pecci is an editor for HealthLeaders.