The rise of consumerism in healthcare: How real-time benefit check can help patients and providers

Patients are increasingly paying more out-of-pocket for their medical care, which is contributing to the rise of consumerism in healthcare. Patients want price transparency when it comes to drug costs but are rarely given it at the point of prescribing. Eighty-seven percent of patients surveyed by CoverMyMeds in 2018 said it would be valuable if providers could share the cost of the medications they intended to prescribe.

Real-time benefit check (RTBC) is an emerging technology that can help improve medication adherence and drug price transparency for patients. Real-time benefit check assists providers and patients by surfacing prescription benefit details at the time of prescribing. The solution empowers patients with information on out-of-pocket cost, prior authorization requirements, formulary alternatives, deductible remaining, pick-up process from pharmacy of choice and patient assistance programs.

During a July 25 webinar sponsored by CoverMyMeds and hosted by Becker's Hospital Review, Jordan Hilsher, sales engineer, and Brian Kolligian, provider solutions consultant with CoverMyMeds discussed the importance of price transparency, factors that drive patient decisions on medication and the advantages of introducing a RTBC solution for both providers and patients.

Two undeniable trends patients face recently are high deductible plans and high prescription costs. The CDC found that 43 percent of adults in the U.S. had a high deductible health plan in 2017, up from 26 percent in 2011.

In 2017, the average out-of-pocket cost on prescription claims for patients with high deductibles was $270 compared to $29 for patients with copayments, according to a 2019 CoverMyMeds case study, Improving Prescription Decision Support with RxBenefit Clarity.

A 2018 survey by the Henry J. Kaiser Family Foundation found that 10 percent of U.S. patients are uninsured and 23 percent of prescriptions are cheaper to purchase without insurance.

"Looking ahead in the foreseeable years, with the increase in specialty medications these cost decisions are only going to become more important and more complicated," Hilsher said.

In this environment, it's important for providers to understand what factors influence patient medication choice so prescribers can best meet patient expectations when discussing treatment options at the point of care.

4 components that influence patient decisions

Hilsher discussed the most significant factors driving patient decisions regarding medication.

1. Affordability. According to the CoverMyMeds survey, in 2018 the average American family of four with insurance through their employer spent over $12,000 on premiums and out-of-pocket costs, with the median household income recorded as $61,000 per year. "What that tells us is that the average American household in 2018 was spending roughly 20 percent of their annual income on healthcare," Hilsher said. "That's pretty eye-opening … this creates [a huge burden] for families financially."

2. Quality. This is the driving force for patients who always opt for the latest and greatest medications, such as patients who refuse to price shop and regularly choose branded medications over generic labels.

3. Time. Patients with a debilitating diagnosis are usually focused on getting whatever treatment is necessary as quickly as possible to help them feel better. "When patients encounter moments like this, their health decisions are dictated by how quickly they can get access to treatment," Hilsher said.

4. Convenience. In terms of patient choice and the consumerization of healthcare, convenience plays a significant role in patient decisions regarding medication. To some, spending extra money to pick up medications at a pharmacy closer to home is worthwhile when they consider the time saved.

Benefits of RTBC for providers and patients

Real-time benefit check can alleviate challenges patients face with medication access. Providers can also benefit from real-time information that taps into the pharmacy network and connects directly with payers.

Surfacing prescription benefit details via RTBC enables timely discussions about clinically appropriate and affordable medications. This allows providers to prescribe suitable alternative medications, which increases the likelihood of a patient adhering to their healthcare plan.

"RTBC is a real-time transaction that's taking place behind the scenes, it's not reliant on a formulary that is maybe updated once a week," Kolligian said. "You're getting that real-time information right away."

Avoiding a prior authorization and the paperwork that comes with it, as well as the three-pronged conversation between provider, patient and payer, frees up valuable time for physicians and clinical support staff, allowing more time for direct patient care.

Knowing information ahead of time — such as high costs of medications and whether they are covered by the patient's insurance or not — reduces time to therapy and prescription abandonment. It eliminates the shock factor of expensive medications and affords time for a patient-prescriber conversation about alternative options. 

"By allowing [patients] to have access to tools such as a RTBC solution, they have the ability to be informed about what medications they're on, how much it may cost and having that idea of what a visit to the doctor or pharmacy is going to cost," Kolligian said. "By proactively being able to manage their own savings, patients can use the same tools to get that information ahead of time about how much it may cost to get that medication."

Find out more about CoverMyMeds by clicking the link, and view the full webinar here.


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