Public Health

Enable real-time Rx benefit info to boost truth in drug pricing

Jennifer Lubell , Contributing News Writer

A standardized real-time prescription benefit (RTPB) tool embedded in EHRs would help patients and physicians make cost-informed decisions on prescription drugs while improving price transparency and medication adherence, according to an AMA Council on Medical Service report adopted at the November 2021 AMA Special Meeting.

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Patients and their physicians making joint decisions on prescription drugs don’t always have timely information on drug prices. RTPB embeds up-to-date, patient-specific coverage in the e-prescribing workflow, making it easier for doctors to access benefits and expected out-of-pocket costs for a specific drug or pharmacy.

An RTPB tool integrated into the Johns Hopkins EHR reduced physicians’ prior-authorization burden and saved patients’ money while improving adherence to medications, according to research cited in the council’s report.

The technology ensures that “neither patients, physicians, pharmacists, nor payers would be burdened with the time-consuming process of manually cross-checking current formularies and potential medication alternatives,” says the report.

However, “a standard is needed to progress beyond the current proprietary and incomplete RTPB technology landscape and allow all physicians access through any EHR to any patient’s specific benefit information,” the council report says, while noting that the technology is “not a panacea that can solve the much broader problem of prescription drug cost transparency in all contexts.”

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Several efforts at the national level have worked toward development and implementation of a standard RTPB tool. AMA policy and advocacy have also supported the development of RTPB and other tools to improve prescription-drug price transparency.

To help empower patients and physicians in making better prescription-drug decisions, the AMA House of Delegates (HOD) adopted new policy to:

  • Continue to support efforts to publish an RTPB standard that meets the needs of all physicians and other prescribers, using any EHR, and prescribing on behalf of any insured patient.
  • Advocate that all payers—that is, public and private prescription drug plans—be required to implement and keep up to date an RTPB standard tool that integrates with all EHR vendors, and that any changes that must be made to accomplish RTPB tool integration be accomplished with minimal disruption to EHR usability and cost to physicians and hospitals.

Delegates also directed the AMA to “develop and disseminate educational materials that will empower physicians to be prepared to optimally utilize RTPB tools and other health information technology tools that can be used to enhance communications between physicians and pharmacists to reduce the incidence of prescription abandonment.”

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In addition, the HOD modified existing policy to support “public and private prescription drug plans in offering patient-friendly tools and technology that allow patients to directly and securely access their individualized prescription benefit and prescription drug cost information.”

Also, delegates modified policy calling for the AMA to ask the Office of the National Coordinator for Health Information Technology to include proven and established RTPB criteria within its certification program.

The AMA also will advocate that any policies requiring health IT developers to integrate RTPB systems within their products do so without disruption to EHR usability and at minimal to no cost to physicians and hospitals—providing financial support, if necessary.

Read about the other highlights from the November 2021 AMA Special Meeting.