3 Factors Contributing to Higher Drug Costs Today

It’s well known that high drug costs prevent many patients from receiving the treatments they need or require patients to sacrifice other necessities to pay for their prescriptions. “Physicians see every day that costs are a major obstacle to our patients getting the right medication at the right time,” said Dr. Jack Resneck, chair of the American Medical Association board of trustees.

Increasing drug prices also impacts other stakeholders, such as health plans and plan sponsors, who may raise insurance premiums to offset higher prescription costs and/or expand prior authorization and step medication programs to manage usage.

At Benmedica, we recognize many reasons behind increasing drug prices and develop solutions to help both patients and payers save money on their prescription costs. Our work involves communicating savings opportunities to doctors through their established Electronic Health Records (EHRs) to ensure that they can select optimal drugs for their patients during their prescription ordering process.

Below are some of the factors and trends we see impacting drug prices and what payers can do to help lower costs for everyone.

1. Information Shortages During Office Visits

One of the most pressing issues in reducing drug costs is the lack of actionable information available to doctors during patient visits. When doctors search for drugs in their EHRs to prescribe for their patients, they often find only general information like a drug’s tier level. This doesn’t give them enough data to know what the copay is, if their patient can afford the drug, or what lower-cost alternatives might be available.


Typical electronic prescribing display


This problem is so prevalent that nearly 90% of clinicians report difficulty in understanding patient drug costs. And, when doctors can’t prescribe the drugs that meet their patients’ health needs and financial realities, the result is often prescription abandonment and poorer health outcomes.

With access to better information, “physicians can enhance patient-centered care by balancing costs and the potential for patient adherence to prescriptions in their decision-making related to maximizing health outcomes and quality of care for patients,” states a recent American Medical Association Board of Trustees report. “Improving drug price transparency would increase patient and physician awareness of the overall costs associated with different prescription drug treatment options and ultimately facilitate better-informed, shared treatment decisions that could help reduce prescription drug spending.”

One significant savings opportunity available to payers is guiding doctors’ drug choices by communicating information critical to drug selection. Knowing copay costs, lower-priced alternatives, and preferred pharmacies can help doctors initially choose the medications their patients can afford, reducing payers’ drug spending, saving doctors time, and saving patients on their prescription costs.


Enhanced electronic prescribing display showing copays and lower-cost alternatives


2. Inefficient EHR Workflows That Lead to Rework

Another factor inflating drug costs for patients is their doctors’ electronic prescribing system. More comprehensive formulary information conveys information better, is easier for doctors to use, and simplifies the prescription-writing process.

Take for instance Electronic Prior Authorization (ePA). Though this capability has been available for years, it has only recently been mandated by the Centers for Medicare and Medicaid (CMS). ePA is vital to helping patients access medications because it facilitates the process of getting patients on therapy and helps bypass prescription abandonment due to prior authorization delays or rejections.

Even communicating that a drug requires a prior authorization is a step in the right direction. If doctors know about PA restrictions, they can either proactively choose an alternative, alert their patients that their drug needs to be approved, or take necessary steps to satisfy prior authorization requirements. Gaining access to plan prescribing requirements can improve efficiency.

Real-Time Pharmacy Benefit (RTPB), an emerging capability slowly being adopted nationwide, promises to improve drug price transparency by displaying patient-specific information like copay costs and preferred pharmacies. While this is certainly a welcome advancement in eRx technology, RTPB becomes a burden on doctors if they must run checks for the drug they prescribe then change prescriptions and re-run a check to see if the next selection is correct.

We believe that formulary information and real-time tools should be of high quality to save physicians time, not add to their burden. Formulary alternatives and PA approval criteria are both steps in the right direction.

3. Competing Priorities

Even with advancing EHR capabilities, cost information is difficult for doctors to identify during the office visit. Frequently the cost of the drug communicated is the list price which doesn’t include rebates from drug companies to payers. These rebates may be for 50% or more of the list price. Without accurate cost information, doctors may be choosing more expensive drugs over alternate brands.

Benmedica helps payers and employers provide drug cost information as part of the formulary data sent through EHRs. Payers can save more on drug costs by providing the information doctors need to make better selections and taking advantage of pharmaceutical company rebates. Today, sharing rebate information and net costs of drugs is an anathema.

Aligning around the common goal of finding the right drug for the patient’s health and budget can create savings for both payers and patients.

Reducing Drug Costs for Everyone

Payers have the opportunity to reduce their drug spending while helping their patients save too. By enhancing the formulary data they send to doctors through EHRs, payers can inform physician prescription decisions and drive lower-cost choices. All of this is possible with today’s current capabilities and infrastructure.

When your plan is ready to take advantage of the untapped savings opportunities afforded by better formulary data, contact Benmedica for an analysis of just how much you could be saving on your drug spending.