America’s ‘sky’s the limit’ drug pricing policy

When was the last time you bought a prescription from a pharmacy? How much did you pay for it? Did you pay out-of-pocket or was it included in your insurance?

Americans pay the highest retail prices for prescription medications in the world. According to a news article published by the American Medical Association in April 2019, U.S. spends nearly $224 billion a year on prescription drugs. In 1990, the share the nation spent on pharmaceuticals accounted for 5.6% of the total health care spending, and this amount rose to nearly 10% in 2017. 

Even common drug costs skyrocketed.  Insulin’s price tripled between 2002 and 2013, though there were no notable changes in the formulation or manufacturing process. EpiPen has seen a price hike of more than 400 percent. When Myland purchased the rights to EpiPen in 2007, this life-saving auto-injector pen cost about $50. In 2018, its price is slightly over $600 for a two-pack.

Cancer drugs can cost more than $100,000 every year.  Bavancio, a cancer drug approved in March 2016, costs about $156,000 a year per patient. Zolgensma, a gene treatment for spinal muscular atrophy, costs an eye-popping $2.125 million per patient. It is by far, the most expensive drug on the market. 

The exorbitant cost of drugs can be too much for many patients, so many skip doses of their medications or split pills. Others abandon treatment altogether.

How can we offer value-based care when pharmaceuticals are boring a hole in our pockets? RxRevu offers a solution. 

Offering value-based and consumer-driven care at the point of sale

RxRevu is a Denver-based company that offers prescription decision support tools. It is an industry leader thanks to its innovative EHR-integrated technology, which allows healthcare professionals to make more informed prescribing decisions by considering everything from a patient’s medical history and individual insurance coverage, to the out-of-pocket cost that patients will pay at the pharmacy. 

RxRevu offers their SwiftRx® solution to promote cost transparency, improve patient safety and satisfaction, and support data-driven medication savings opportunities. The solution is primarily focused on improving the value of healthcare through better prescribing decisions.

SwiftRx® Direct is the leading integrated cost transparency solution on the market. This solution brings real-time, patient- and pharmacy-specific cost information, coverage restrictions, and therapeutic alternatives into native EHR workflows. Giving providers drug cost information at the point of prescribing enables data-driven and evidence-based prescribing decisions that help patients get the care they need at prices they can afford.

This technology, which is often referred to as real-time benefit check, allows prescribers to view prior authorizations and patient-specific cost information that is aligned with formulary and benefit data. This patient-specific information is sourced in real-time via RxRevu’s partnerships with payers and PBMs in order to inform prescribers before medication selection and fulfillment.  SwiftRx gives prescribers the ability to order lower-cost therapeutic alternatives, and drive in-network fulfillments for health systems with pharmacy departments. The platform also provides prescription health analytics to help organizations understand prescribing patterns and create best-practices for behavior change.

In my podcast interview with Carm Huntress, CEO at RxRevu, he said that real-time benefit check started to become an emergent standard about three years ago. He mentioned that most of the major payers and PBMs that came to them showed interest in what the company is doing at the point of care.

“We’re doing a lot of work in clinical decision support, so helping the doctor know clinically, hey, this is the appropriate drug. And then with real-time benefit, it was kind of a great marriage of clinical data plus cost transparency and bringing those two ideas together at the point of care.  And so that’s really what led us into…three or four major relationships with insurance companies to run these transactions on behalf of their members and then bring that data to the point of care on behalf of providers. So when they make that prescription decision, right in their EHR they actually see that costs of that drug. They can also see therapeutic alternatives that are lower costs. They could see if the drug has a prior autho or not, as well as different fulfillment channels. Like is it better for the patient to go to a different pharmacy or potentially get the drug via mail order? So, it’s a powerful tool in terms of really helping providers make more informed prescription decisions.” explained Carm further.

In December of 2019, RxRevu announced a ground-breaking partnership with Cerner.  This partnership integrated RxRevu’s real-time benefit check technology into the Cerner EHR, allowing prescribers to choose the most cost-effective medications for millions of patients.  Earlier in the year, RxRevu also announced their integration with Epic’s EHR, making the technology available to healthcare systems and providers who leverage Epic’s EHR.

RxRevu’s revolutionary technology is much-needed in our country’s current rising prescription cost turmoil. Not only does it allow primary care providers to prescribe the right medicine for each patient, it also takes into consideration alternatives and less expensive options that do not require authorization, consequently providing patients the value-based and consumer-driven care they deserve. If you’re a provider, this platform unifies siloed data sources, streamlines the medication ordering process and measures prescribing behavior, helping you make more cost-effective and accurate decisions.

For payers and PBMs, the SwiftRx® platform provides actionable influence at the point of prescribing and gives you the reports and analytics needed to better manage pharmacy outcomes and network performance.

To listen to my podcast with Carm Huntress, visit https://outcomesrocket.health/rxrevu/2019/10/ today. 

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