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Readers Write: It’s Time for Drug Price Transparency

February 14, 2018 Readers Write 9 Comments

It’s Time for Drug Price Transparency
By Stanley Crane


Stanley Crane is the chief technology officer of InteliSys Health of San Diego, CA.

EHR vendors face a tough challenge in deciding which new features to develop and integrate for their next release and which ones to leave on the cutting room floor. The benefits of each potential enhancement must be weighed against the costs, usually measured in programming time. Moreover, features required for Meaningful Use and MIPS must be included, making the triage even more difficult.

However, EHR companies are missing the boat if they neglect to add a feature that could have a massive impact on their clients’ patients. I am speaking here of prescription drug pricing comparisons, built directly into the EHR workflow of prescribers

We’ve heard a lot about drug price transparency lately. But the public discussion hasn’t come close to the truth.

There are vast differences in the prices pharmacies charge for the same drug from the same manufacturer within the same geographical area. For example, the price of generic Plavix (clopidogrel) ranges from $6.16 at one pharmacy in Aurora, CO to an amazing high of $150.33 at another pharmacy just a few steps away. That’s the equivalent of a gas station charging $72 per gallon for unleaded regular when a station across the street is asking $2.95. This is merely one of literally millions of examples of the absurd variation in retail drug prices.

Most doctors and patients are unaware that retail drug prices vary by so much. As a result, many patients go to the pharmacy, get hit with sticker shock, and walk out without picking up their medication. Others pay far more than they should for the drug because they’re unaware of widespread price variance.

A handful of companies now sell prescription drug price comparison tools directly to consumers. These haven’t had much impact, however. First, because not many people know about them. But also because it’s too complicated for the patient to move their prescriptions to another pharmacy.

Imagine how the situation would be different if a patient’s own doctor could tell him or her what their medications would cost at different pharmacies, regardless of whether the patient has insurance.

What our healthcare system needs today is a modern price comparison tool that is integrated with an e-prescribing tool, ideally within an EHR. The range of prices for a particular drug would appear on the prescribing screen within milliseconds of a physician selecting that medication. Using real-time pricing data from pharmacies, the software could show the cost of that drug at the closest pharmacies to the doctor’s office or the patient’s home or workplace. None of this information is available via EHRs on the market today.

Such a solution could use the patient’s insurance information in their doctor’s EHR, as well as search health plan databases to determine a patient’s out-of-pocket cost (after factoring in deductibles, co-payments, and out-of-pocket minimums). If the patient is on the hook for the cost — either because of a high deductible, high co-pay, or because he or she is uninsured –the software could show the cash price of the medication. It could also indicate whether the cash price is lower than the co-payment under the patient’s plan, ensuring that the patient pays the lowest price each time.

At the patient’s choice, the doctor could then send the e-prescription to the most convenient pharmacy that charges the lowest price for that drug. If the price is still too high for the patient, the software could automatically analyze the selected drug against therapeutically equivalent alternatives, enabling the doctor to prescribe a lower-cost alternative, again comparing the prices at local drugstores.

Transparency in prescription drug pricing offers several benefits. Patients are likely to have better outcomes if they fill their prescriptions and adhere to their prescribed therapy. Physicians can garner higher quality scores if their patients take their meds and control their chronic conditions. Lastly, if price transparency becomes widespread, some pharmacy chains will be forced to lower their prices to avoid losing customers to lower-priced stores or chains. If that happens, the whole system benefits, including patients, plans, employers, and taxpayers.

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Currently there are "9 comments" on this Article:

  1. Stanley –

    Putting more complexity into EHRs to handle price-choice decision making puts more work on clinicians that, in other areas, is something that consumers do all the time.

    The core problem is that we have an e-prescribing process that chooses the pharmacy at the point of prescribing, rather than allowing the patient to direct their e-prescription to the pharmacy of their choice. Imagine a system like I’m told they use in Australia, where the prescription goes to the “cloud” and when the patient decides which pharmacy they want to use (e.g., by price shopping), they or the pharmacy direct the prescription to that place.

    Let’s put patient responsibility into our workflows rather than building far more complexity into our EMRs. There are many other critically important things that our informatics and IT folks could be working on.

    Best regards
    Joe Schneider, MD

    • Imagine a system where Doctors gave their patients a “ticket” – perhaps just a slip of paper – that could be redeemed at any pharmacy of the patient’s choice for the drug described on the ticket.

      But seriously, that would never work.

      • Why not embed this functionality in to the patient portal and let the patient take on the leg work and the extra clicks?

    • Sounds like a good use of blockchain technology in giving patients control of their now-electronic prescriptions if they want it, especially since e-prescribing for patients is less convenient than being given a paper prescription they can hand-deliver to the pharmacy of their choice when they are ready. It also keeps the doctor out of time-wasting pharmacy lookups, such as trying to figure out which Walgreens is closest to the practice or to the patient’s home. There’s not much of a business case for developing this technology and moving it through a myriad of state and federal prescribing laws, however, so as nice as it would be for patients, it probably won’t happen.

  2. “Imagine how the situation would be different if a patient’s own doctor could tell him or her what their medications would cost at different pharmacies”

    Doctors didn’t spend six years in medical school to learn how to help their patients find the cheapest pharmacy.

    Of course there should be transparency in pricing. But let’s not waste physicians’ time by putting more administrative work on their plates.

    • Did you take the Hippocratic Oath in Med school? does the slightest thought of helping your patients concern you at all ? or did you sell out to drug companies ?
      get real. increase workload is a reality for everyone in america not just physicians

  3. I have a few concerns about the article Mr. Crane wrote on Drug Pricing Transparency and respectfully disagree and question how much he really understands about the physician office workflow. While I definitely agree that there needs to be more transparency and an easier way to do price comparisons, my recent experiences suggest that his suggestions don’t seem realistic.

    A price comparison tool that is integrated with an e-prescribing tool, ideally within an EHR sounds easy enough, but when I think of the frequent changes of PBM pricing and insurance formularies being integrated and updated in the EHRs, not to mention try to envision the extra time this would take the providers (doctors and/or nurses) to review that and discuss with the patient, I just see more time spent in the visit, not less. I’m trying to imagine my aging parent having that conversation with the doctor.

    Also, it has occasionally been my experience that the cost for the Rx is actually cheaper if I just skip using the insurance benefit and pay cash.
    I recently had my PCP order an Rx and send it to the pharmacy I had identified as a Favorite Pharmacy and then two minutes later I remembered that my insurance changed January 1st and that Favorite was not a Preferred Pharmacy so had to change it. Getting the prescription transferred to new Preferred Pharmacy in-network wasn’t complicated. The new pharmacy did all the work and called/faxed over the request. But it did take a few minutes more time so return trip for me since I didn’t want to wait. What WAS complicated is that neither pharmacy could give me pricing until they had the order in their system. So, at no point could I compare pricing between pharmacies using my insurance, paying cash or using GoodRx. That was really annoying and seems like a huge waste of a lot of peoples’ time. I would happily use a drug price comparison tool if I could have one online or especially as an app on my smart phone. Then I could enter in my insurance info, my pharmacies, and compare to cash pricing too.

    Call me crazy, but I just don’t think a patient’s doctor wants to engage in a discussion on costs of medications at different pharmacies. Nor do I think their staff want to have that conversation. Today’s office staff are already trying to accomplish a LOT within a 10-15-minute appointment.

    What I wholeheartedly advocate is putting some pressure on insurance companies to quit making this whole pricing issue so complicated. Clearly, they benefit from the lack of transparency. They KNOW most people won’t take the time to price shop, especially when they are sick and not feeling well. I remember once learning that if I purchased an Rx with my insurance benefit it would cost $200 (and be applied to the deductible) but if I paid cash price for the same drug, it would only cost me about $20. That seemed like a no brainer to me. Why would anyone pay ten times more just so they could apply it to their deductible!

    Back to the drawing board on this idea please!

    • There’s no incentive for the provider to spend time doing a price comparison for the patient. Nor is it a good use of their skill set. I think the insurance company has the incentive to reduce their payout by helping the patient shop around.

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