The Trump administration recently proposed a rule that would require prescription drug makers to include average wholesale prices in their TV ads. It is billed as part of the overall effort by the Centers for Medicare & Medicaid Services (CMS) to empower patients and lower prescription drug prices.1 But is there a better way to reach those goals?
High drug prices are harming consumers — and the entire health care system. The proposal to add prices to drug ads is intended to help consumers make informed choices. But we are concerned that simply adding raw price data could cause confusion and lead to misinformed decisions.
Instead, OptumRx supports steps that provide better drug price transparency and lower drug costs. One tool to do so is PreCheck MyScript®. It allows providers to see cost, coverage and prior authorization for individual patients while prescribing medications in real-time.
Data versus information
Empowering consumers is a laudable goal. But the emphasis on consumer advertising is a distraction from the real need for accurate, personalized, actionable information that can produce genuinely empowered decisions. In contrast, PreCheck MyScript is a great example of the right way to use the power of timely, personalized information to help people make better health care decisions.
If the goal of the proposed CMS rule is to promote informed decisions, simply publishing wholesale prices is the wrong way to do that.
The reason why this is the wrong solution has to do with the way most people access prescription drugs.
The majority (about 72 percent) of prescription drugs are dispensed via a pharmacy benefit plan.2 The price the member pays will depend on multiple variables — their benefit plan, the plan’s pharmacy network, and any discounts their plan have negotiated with the pharmacy.
Consequently, the member price for any specific drug could be significantly different than the list price. Just adding raw price data to this situation could cause confusion.
For example, an ad might feature the price of a low, uncommon dose and form of a drug, which may mislead the consumer about the actual out-of-pocket drug cost. Or people might mistakenly assume they will be required to pay the high list price disclosed in an ad and decide to not accept treatment. Either of these examples may lead to consumer confusion. When people are confused, they can’t make good health decisions, which can have a negative effect on their long-term health.
PreCheck MyScript: A proven solution
Genuinely empowered consumers have access to all of the critical information they need to make an informed decision. PreCheck MyScript represents a meaningful step toward better drug price transparency and lower drug costs. It provides physicians with real-time data on all of the relevant clinical and benefit plan coverage features for a given patient — within their existing electronic medical record system.
PreCheck MyScript consolidates what medications are covered, highlights any clinically appropriate, lower cost options and calculates exactly how much they will cost this individual patient. PreCheck MyScript can even say whether home delivery or retail will be least expensive.
But PreCheck MyScript does not simply search on lower cost alternatives. OptumRx aims to transform how physicians get prescription information. For example, providers receive clinical surveillance flags, including opioid alerts, and specialty medication alerts.
Sixteen months of real-world experience with over 110,000 physicians and 2.6 million members have resulted in multiple examples where PreCheck MyScript delivered cost and health benefits:
- When prescribers select the lower cost alternatives, members save an average of $80 per prescription.3
- When a doctor shifts to an alternative drug based on the information provided by PreCheck MyScript, clients save an average of $415 per switch.4
- 80 percent of expensive tier 3 drugs were switched to therapeutically equivalent lower cost alternatives.5
- Medication adherence improved by up to 4 percent for three chronic conditions.6
Giving doctors contextualized, real-time data — while the patient is still in the exam room — is the best way to empower the individual health care consumer. PreCheck MyScript is one way to simplify and clarify the prescribing process. The result is better health outcomes and lower out-of-pocket costs.
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- U.S. Centers for Medicare & Medicaid Services. Press Release. CMS Proposes to Require Manufacturers to Disclose Drug Prices in Television Ads. Published Oct. 15, 2018. Accessed March 4, 2019.
- Peterson-Kaiser Health System Tracker. What are the recent and forecasted trends in prescription drug spending? Posted Dec. 10, 2018. Accessed March 4, 2019.
- Third party analysis of OptumRx claims data. July 1017 – November 2018 based on 2.6 million members, >110,000 providers, and 13.3 million transactions using PreCheck MyScript.
- OptumRx data. Measurement of PreCheck MyScript impacted prescriptions within the diabetes therapeutic class, the statin therapeutic class, and the hypertension therapeutic class. Savings represents a pre/post methodology. Pre period is October 2016 to September 2017, and post period October 2017 to September 2018. Population included in the measurement was continuously enrolled.
STATEMENT REGARDING FINANCIAL INFLUENCE:
This article is directed solely to its intended audience about important developments affecting the pharmacy benefits business. It is not intended to promote the use of any drug mentioned in the article and neither the author nor OptumRx has accepted any form of compensation for the preparation or distribution of this article.