Industry Voices—Improving price transparency, outcomes through pharma-provider partnerships

physician assistant
In their quest to help patients adhere to drug therapies, providers increasingly look to pharmaceutical partners to shed light on prescription prices to ensure patients can afford their medications. (Getty/wmiami)

Soaring prescription drug costs pose a challenge for providers and patients alike, creating second- and third-order effects for all stakeholders in the healthcare industry. A recent OptimizeRx drug cost survey reported that patients raise the issue of prescription costs with providers almost 40% of the time and that 91% of physicians believe they have a responsibility to address healthcare costs with their patients.

Despite this stated desire to discuss prescription costs, the two groups find themselves hindered by the lack of transparency surrounding total drug prices. JAMA reported in 2019 that prices among popular prescription drugs continue to increase by an average of 76% over a five-year span.

Additionally, 98% of the prescriptions included in the study saw annual and biannual price increases, with a large number of those doubling in price over the study’s lifetime.

The reality is that drug costs will remain one of healthcare’s primary challenges for the foreseeable future. As patients lean harder on physicians for help, pharma-provider partnerships built on transparent information flow and improved collaboration around the patient will become increasingly important.

Prescription costs: A top priority

Most Americans see drug costs as one of healthcare’s top reform priorities. In truth, the clamor to improve the outlook runs deep across all industry stakeholders, although tensions may be highest among providers and patients. At the same time, patients and providers are most closely aligned in their desire for price transparency.

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Physicians hear patient frustrations related to drug costs firsthand, but neither has ready access to information to improve decision-making. A 2019 survey of healthcare consumers found that 60% of participants had tried to locate information about out-of-pocket costs, and 51% were unable to locate it easily or accurately.

Notably, 73% of physicians said that the patient’s out-of-pocket drug costs factor heavily into their prescribing decisions, but without collaboration with pharma, they lack the resources to consider price when making decisions.

The federal government has taken notice of this struggle as well and has moved to improve drug pricing transparency with its American Patients First (PDF) program. In it, the U.S. Department of Health and Human Services has mandated that drug companies disclose the list price of prescription drugs in TV commercials and other direct-to-consumer advertising. The result, it believes, will increase transparency and inform consumer decision-making.

Improving transparency, collaboration

In their quest to help patients adhere to drug therapies, providers increasingly look to pharmaceutical partners to shed light on prescription prices to ensure patients can afford their medications. The obvious starting point for greater collaboration is the electronic health record (EHR)—where the majority of physicians prescribe medications.

In fact, as of December 2018, physicians had completed more than 6.3 million drug cost checks in the EHR, up from 298,000 in January of that same year.

With the right point-of-prescribe network in place, pharmaceutical companies can communicate directly with physicians via the electronic interchange. Physicians can search for a drug by name in the EHR and gain real-time access to price information for brand-name pharmaceuticals as well as their generic counterparts. Where they previously had no information about price and affordability, they can immediately decide with patients which options are best and also access coupons and vouchers to offset costs. 

As the call for drug pricing transparency grows louder, manufacturers that communicate savings to providers will position themselves favorably and increase the value proposition of partnerships. Systems that advance pharma-provider partnerships this way can alleviate the likelihood of unused vouchers—equating to billions in missed opportunities every year—and ensure physicians better engage their patients for improved outcomes.

The future of healthcare

Emerging healthcare trends point to a growing movement toward more informed consumers. In place of the previous model that treated acute illnesses, new models will focus more on disease prevention, managing chronic illness and maintaining wellness. Patients will increasingly take charge of their own health, taking on active, informed roles that increase the likelihood of improved outcomes. Those same patients will have increasingly more choices in where and how they get their care, and price transparency will incentivize wise buying decisions.

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State and federal governments have initiated more than 900 different bills intended to control costs and improve access to healthcare. Drug price transparency will empower providers to present multiple treatment options to their patients, choose the treatment that’s best for the patient and even verify whether the patient filled the prescription.

The key is getting the right information to providers and patients at the right moment: within e-prescribing workflows at the point of care.

Armed with the knowledge that 90% of physicians and 85% of patients welcome EHR-based copay information, pharmaceutical companies stand poised to help all stakeholders improve outcomes by helping providers access drug pricing information.

The move would improve the healthcare experience, build value for other stakeholders and build partnerships among others in the industry.

Miriam Paramore is president and chief strategy officer of OptimizeRx.