Memo to EHR vendors from an EHR CTO: It’s time for true drug price transparency

EHR vendors face a tough challenge in deciding which new features to develop and integrate for their next release and which ones to leave on the cutting room floor.

The benefits of each potential enhancement must be weighed against the costs, usually measured in programming time. Moreover, features required for Meaningful Use and MIPS must be included, making the triage even more difficult.

I should know. I spent more than 20 years as CTO and chief innovation officer at Allscripts, one of the nation’s largest EHR vendors. During those two decades, I led multiple teams in the development of numerous major enterprise solutions and a myriad of new product releases. I know firsthand how tough it is to wade through all of the possible options to select just the right enhancements for your clients.

That’s why today I can say with certainty that EHR companies are missing the boat if they neglect to add a feature that could have a massive impact on their clients’ patients. I am speaking here of prescription drug pricing comparisons, built directly into the EHR workflow of prescribers.

Drug prices vary significantly – and most patients have no idea
We’ve heard a lot about drug price transparency lately. But the public discussion hasn’t come close to the truth. There are vast differences in the prices pharmacies charge for the same drug from the same manufacturer within the same geographical area. For example, the price of generic Plavix (clopidogrel) ranges from $6.16 at one pharmacy in Aurora, Colo., to an amazing high of $150.33 at another pharmacy just a few steps away. That’s the equivalent of a gas station charging $72 per gallon for unleaded regular when a station across the street is asking $2.95. And yet this is merely one of literally millions of examples of the absurd variation in retail drug prices.

Most doctors and patients are unaware that retail drug prices vary by so much. As a result, many patients go to the pharmacy, get hit with sticker shock, and walk out without picking up their medication. Others pay far more than they should for the drug simply because they’re unaware of widespread price variance.

To help, a handful of companies now sell prescription drug price comparison tools directly to consumers. These haven’t had much impact, however. First because not many people know about them. But also because it’s too complicated for the patient to move their prescriptions to another pharmacy.

Now imagine how the situation would be different if a patient’s own doctor could tell him or her what their medications would cost at different pharmacies, regardless of whether the patient has insurance. Do you think most patients would welcome that information? You bet.

How it SHOULD work
What our healthcare system needs today is a modern price comparison tool that is integrated with an e-prescribing tool, ideally within an EHR. Let’s imagine how such an application would operate in practice.

The range of prices for a particular drug would appear on the prescribing screen within milliseconds of a physician selecting that medication. Using real-time pricing data from pharmacies, the software could show the cost of that drug at the closest pharmacies to the doctor’s office, the patient’s home or workplace. None of this information is available via EHRs on the market today.

Such a solution could utilize the patient’s insurance information in their doctor’s EHR, as well as search health plans databases to determine a patient’s out-of-pocket cost (after factoring in deductibles, copayments and out-of-pocket minimums). If the patient were on the hook for the cost, either because of a high deductible, high copay or because he or she was uninsured, the software could show the cash price of the medication. It could also indicate whether the cash price was lower than the copayment under the patient’s plan, ensuring that the patient paid the lowest price each time.

At the patient’s choice, the doctor could then send the e-prescription to the most convenient pharmacy that charged the lowest price for that drug. If the price was still too high for the patient, the software could automatically analyze the selected drug against other therapeutically equivalent drugs, enabling the doctor to prescribe a lower-cost alternative, again comparing the prices at local drugstores.

The transparency in prescription drug pricing that this type of solution could provide has several benefits. First, patients are likely to have better outcomes if they fill their prescriptions and adhere to their prescribed therapy. Second, physicians can garner higher quality scores if their patients take their meds and control their chronic conditions. Third, if price transparency becomes widespread, some pharmacy chains will be forced to lower their prices to avoid losing customers to lower-priced stores or chains. And if that happens, the whole system benefits, including patients, plans, employers and taxpayers.

An intuitive value proposition
The value proposition for EHR vendors to adopt such a solution is straightforward. They could offer a feature-rich solution of great value to their customers for a very modest time investment. Those who adopt price comparison tools now will have a first-mover advantage over their competitors, although the tools will likely become a standard feature of EHRs fairly quickly. Further, like the free standalone e-prescribing tools that I helped design for my EHR employer, a modern price comparison tool with the capabilities I’ve outlined would give physicians the ability to help their patients compare drug prices, thereby lowering healthcare costs.

It’s simply the right thing to do.

Stanley Crane is the chief technology officer of InteliSys Health. He was formerly the CTO and the chief innovation officer of Allscripts.

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