Help Preserve Prescriber Choice with Patient Savings Offers in the EHR

As the adoption of price transparency expands, so does the need to provide in-EHR brand savings information


The move toward drug price transparency is real and growing. PBMs and EHR providers are working at breakneck speed to display patient-specific prescription drug coverage and pricing information in the e-prescribing module of the prescriber EHR. This type of technology is known by many names: real time benefit check (RTBC, the term used widely in this paper), real-time prescription benefit, real-time benefits, benefits check, etc. Regardless of the name, price transparency is spreading quickly. Surescripts reports that EHRs serving 80% of prescribers have signed on to offer RTBC information. 2018 saw a 40-fold increase in the number of prescribers using RTBC, and prescribers have used an RTBC tool to view patient-specific prices more than 41 million times. At this point, at least 76% of U.S. covered lives are currently reached with RTBC. Not surprisingly, early feedback from PBMs suggests that the availability of RTBC information in the EHR is driving a switch to lower cost alternative medications. A recent report from CVS Health indicates that among physicians using RTBC, when a prescriber’s first-choice drug isn’t covered by the plan, he or she switches to a covered medication 75% of the time. Furthermore, for prescriptions written by physicians using RTBC, when a lower-cost preferred alternative is presented, physicians switch to the lower-cost alternative 40% of the time.

Fortunately, brand teams have multiple channels through which to provide information about available patient savings that can help HCPs have full transparency into the drug prices their eligible patients are likely to pay. These channels include physical or web-sourced copay cards, hub portals, and in-EHR display of patient savings offers.

In order to assess prescribers’ opinions regarding the ideal integration of brand savings information into the EHR, ConnectiveRx recently conducted 45-minute, in-depth telephone and web-based interviews with 26 primary care and specialty prescribers. To be eligible, respondents confirmed that they e-prescribe personally and use or recommend brand savings programs. The research sought prescribers’ attitudes and preferences regarding the display of both payer-provided drug price information and manufacturer-provided patient savings offers in the e-prescribing module of the EHR. In addition, we asked for prescribers’ recommendations on the ideal integration of patient savings offers within the EHR (e.g., position, timing, frequency, content). Key objectives:

  • Determine how prescribers will use RTBC information
  • Identify how and where prescribers prefer to access patient savings (within RTBC screen, in the eRx module)
  • Pinpoint the most valuable types of savings information

Key Finding #1: Generally, prescribers consider in-EHR price transparency to be a helpful service

Research participants report a high degree of interest in having easy, in-workflow access to RTBC. Overall, prescribers expect RTBC to “streamline” prescribing, leading to fewer call backs. They believe RTBC is likely to influence prescribing where:

  • An affordability problem exists with the drug of choice
  • Alternatives are significantly cheaper, with similar efficacy
  • A prior authorization (PA) is required for the selected medication, but not for an alternative (a link to an electronic PA offsets this for a few)

The most likely use of RTBC data is to check patient-specific prices when initiating new therapy or adding/ changing an existing medication. When renewing a prescription, prescribers are likely to use RTBC information only when 1) the patient has expressed affordability concerns, or 2) the patient is present with the prescriber when the renewal takes place.

In addition, some respondents mentioned a few concerns regarding RTBC:

  • The extra time or extra steps required to view and act on the information
  • The fact that the information is presented after the initial prescribing decision has been made

The survey respondents also provided valuable insights regarding RTBC best practices (Figure 1), including the expectation that the stated out-of-pocket cost automatically includes brand savings offers.

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