Over the past decade, e-prescribing has become nearly universal, reaching 96% of all prescriptions, and real-time benefit tools built to show providers a patient’s cost and coverage at the point of prescribing are now used by more than 90% of active prescribers every month. That maturity has created a new challenge: the providers navigating medication costs have never had more information, while patients largely still don’t.
That maturity has created a new opportunity: extending the same transparency beyond providers to patients and the broader care team.
During a recent webinar hosted by Becker’s Healthcare, Christie Callahan, Chief Product Officer at Interra Health, and Lauren Hackenberg, Senior Director of Provider Capabilities at OptumRx, discussed how real-time cost and coverage information is evolving to create a more connected, patient-centered medication experience.
Real gains, and where the tools still fall short
Hackenberg shared that when real-time benefit tools surface a lower-cost alternative, providers switch the prescription to avoid a prior authorization about 31% of the time on average, with some health systems and therapeutic classes exceeding 50%. Achieving that level of performance has required significant improvements behind the scenes. Callahan explained that Interra Health applies NDC normalization and other intelligence to roughly 3 million prescriptions each month, helping ensure real-time benefit responses accurately reflect patient cost and coverage rather than being disrupted by outdated or repackaged drug codes.
Hackenberg described accuracy in three ways: real-time benefit responses reflect an actual adjudicated claim at the moment of prescribing, OptumRx’s internal metrics show pricing is within a penny of the final cost 93% of the time when prescriptions are filled within three days, and the company has deliberately scaled back the volume of alternatives it displays to providers in favor of ones with higher engagement. “We saw our engagement rates almost double,” Hackenberg said, after narrowing which alternatives were surfaced.
Rather than displaying more alternatives, the goal has been to present more actionable ones, an approach that nearly doubled provider engagement.
Bringing the patient back into the loop
A central theme of the discussion was that the next phase of medication transparency is no longer just about providers. Both speakers noted that today’s digital prescribing workflows often leave patients without the same visibility providers have until they arrive at the pharmacy.
Before ePrescribing, patients could take a paper prescription to multiple pharmacies. Today, prescriptions are typically routed electronically, making it even more important that patients receive timely information about costs, coverage, pharmacy options, and medication access before they reach the pharmacy counter.
Rather than asking providers to manage every aspect of that experience, Callahan and Hackenberg emphasized giving patients, pharmacists, care coordinators, patient support teams, and providers consistent, real-time information so each can play their role in helping patients start therapy faster. The goal is to create a connected experience without adding administrative burden for clinicians.
The conversation also explored cash pricing and discount cards. While these options continue to grow, Hackenberg shared that OptumRx’s data shows insurance benefit pricing beats cash pricing more than 85% of the time for common generic maintenance medications, reinforcing that most patients still benefit from using their insurance coverage when accurate pricing information is available upfront.
Looking ahead
Looking forward, both speakers agreed that the future of medication access depends on delivering the right information to the right stakeholder at the right time. That means moving beyond simply displaying prices to helping patients understand their options while equipping providers, pharmacists, and care teams with the information needed to support informed decisions and reduce delays in therapy.
As healthcare organizations continue to modernize medication workflows, both leaders emphasized that success will come from keeping patients at the center of every decision while making the experience simpler, not more complex, for providers.
As Callahan concluded, “Our purpose begins and ends with the patient.”
This article is based on a webinar hosted by Becker’s Healthcare and Interra Health.
At the Becker's 11th Annual IT + Revenue Cycle Conference: The Future of AI & Digital Health, taking place September 14–17 in Chicago, healthcare executives and digital leaders from across the country will come together to explore how AI, interoperability, cybersecurity, and revenue cycle innovation are transforming care delivery, strengthening financial performance, and driving the next era of digital health. Apply for complimentary registration now.