There is a transparency zeitgeist kicking off right about now. In June was the biggie, the one where health systems now have to divulge their contracted rates with insurance carriers starting January 1, 2021. But this zeitgeist is flowing into drug prices as well. Surescripts just released their real-time prescription price transparency tool. This price transparency tool allows detailed cost and alternative drug information to be seen in real-time. Surescripts, by the way, is owned by several large PBMs (pharmacy benefit managers).
Can the prescriber see how much drugs will cost the patient as they are writing the prescription? The answer is yes if that prescriber is using a tool to display the prices in their EHR (electronic health record) or e-prescribing system. That is pretty cool and could save a whole lot of rigamarole and time for both the prescriber and the patient who doesn’t now have to go the whole way over to the pharmacy to figure out the drug price is unaffordable.
I just want to bring up one point to be aware of: Surescripts is, as aforementioned, owned by some PBMs. PBMs are not exactly non-profits. They do a great job for their shareholders collecting middle-man dollars from pharma and pharmacies and patients alike. The copay amount a patient pays is a decision that is made, in many cases, by a PBM. So, showing the PBM-set patient price at the point of care to doctors increases PBM leverage in conversations with at least pharma. You see what I mean? Maybe that’s good if the PBM actually takes the dollars it shakes out of pharma and gives it to employers or the patients, the government or pays pharmacies they don’t own fairly. Maybe it’s bad if the PBM uses its additional leverage to, I don’t know, start its own GPO (group purchasing organization). In Switzerland. Wait, what?! Yeah, that happened.
All I’m saying is, this is a tangled web we weave with implications for pharma, pharma's PBM negotiations, pharmacies and patients as patients and also patients as members of plans.
Here’s a really important point that I need to make. Nobody in the health care industry is conflict free. Not PBMs, not IDNs (integrated delivery networks), not you, not me. I love transparency and I love sparing doctors and clinicians administrative burden. If I were a provider organization, I would definitely use this tool. But here’s what I need to say… in addition to transparency showing the copay of a drug and the best pharmacy to get it at, these systems also make transparent the underlying levers of the system itself if you look at them in a kind of pattern-wise way. So, if I’m a doctor and I find it weird that the lowest price is always at the pharmacy owned by a PBM, for example. Yeah, it’s up to you to start asking questions. My hope is that everyone sticks with the spirit of the endeavor and gets to the heart and the potential of transparency and chooses the path that benefits the patient the most.
To that end, I am speaking in this health care podcast with Carm Huntress, who is the CEO and cofounder of RxRevu. We talk a lot today about how showing prescribers how much drugs cost can really help patients avoid financial toxicity and/or a whole lot of running around getting prescriptions changed to drugs that are on-formulary.
You can learn more at RXrevu.com. You can also connect with Carm Huntress on Twitter at @carmhuntress.
Carm Huntress is CEO and cofounder of RxRevu. As CEO, Carm has successfully taken prescription decision support from a concept to a reality for physicians, payers, health systems, and patients. At the core of this work is to transform the value of health care through better prescribing decisions. At a national level, Carm has played a key role in supporting interoperability and patient access to data through the development of the Fast Healthcare Interoperability Resources (FHIR) standards and other projects with the Office of the National Coordinator (ONC).
04:25 The protracted way doctors prescribe drugs right now.
06:15 “What is the macro thing we want to have happen here?"
08:10 Where we are today.
08:38 Value-based contracts.
10:10 Who is hurt by higher-cost alternatives.
12:50 The number one thing doctors get out of drug cost transparency.
13:20 The second thing doctors get out of drug cost transparency: patient satisfaction.
13:55 The downside to drug cost transparency.
14:40 “We gotta back up and just say, ‘What do we want?’”
16:30 How real-world evidence is going to affect drug pricing and rationalization.
17:43 “They’re waking up to the new world.”
20:20 How copays play into this.
20:45 “What’s the total cost, what’s the patient cost, and what are the alternatives?”
22:00 The history of formulary and benefit.
26:41 The problem with specialty drugs.
29:30 “Can we just start with first principles here?”
29:40 “We don’t really think about socio-economic factors.”
29:43 “What can you really pay?”
31:00 Why do IDNs care about drug pricing transparency?