[ad_1]
By Phil Galewitz, Kaiser Health News
When Mary Kay Gilbert saw her doctor in May for a skin infection in her leg, she was not surprised to receive a prescription for an antibiotic cream.
But Gilbert, 54, a nurse and health consultant, was shocked when his doctor clicked on his office computer and told him that the drug would cost $ 30 a year on his Blue Cross and Blue Shield plan.
"It was kind of awesome to know that information," she recalls to a doctor in Edina, Minnesota.
Allina Health, a large network of Minnesota hospitals to which Gilbert's doctor belongs, is one of many healthcare systems and insurers providing physicians with real-time information on drug prices to help patients avoid "sticky shocks" at the pharmacy.
The pricing tool, built into the physician's electronic medical record and prescription system, shows the amount of fees that patients will pay out of pocket based on their insurance and pharmacy. This allows the doctor to find a cheaper alternative, where possible, and begin the process of obtaining a drug authorization, if the insurer requires it. .
Soaring drug costs have been at the center of the growing national debate about the reorganization of health care in the United States.
Studies show that consumers give up hundreds of thousands of prescriptions every year to the pharmacy, often because of high prices, putting their health at risk and often resulting in higher costs.
According to experts, this tool can help consumers – who face rising fees and higher deductibles – find cheaper options for their doctor.
Nevertheless, doctors have been slow to adopt the technology, sometimes because of fears of getting bogged down in lengthy discussions about the cost of drugs. Humana, for example, introduced its drug pricing tool to its network doctors in 2015. Today, less than 10% use it, company officials said.
But the tool also has serious limitations. Because price negotiations between insurers, drug makers and intermediaries are often highly competitive and secretive, tools often do not have data for everyone. For example, Allina works for only about half of her patients. This is because not all drug benefit managers share their cost information for health insurance plans, and those who do so often provide only a fraction of their information.
"Doctors do not use it because they do not have the data for all their patients and health plans do not promote it to doctors because doctors do not have the technology in place, "said Anthony Schueth, consultant health information technology in Jacksonville, Florida. "This can be a powerful tool when it works, but for the moment, pilots are not present everywhere for widespread adoption."
At a hearing last month, Senator Martha McSally (R-Ariz.) Asked a senior Trump administration health official to explain why so many patients do not have the time. did not have access to information about the prices of prescription drugs at their doctor's office.
"It's America." Why can not we have this tool available now? "She asked." The data is out there; the information is out there. is it necessary for this to happen?
Technology benefited from a boost last month when Medicare and Medicaid Service Centers (CMS) asked all Medicare drug plans to include such a tool in the electronic prescription system of their drug plans. doctors from 2021.
The details of what consumers spend out of pocket for drugs are provided by the Pharmacy Benefits Directors, or PIMs. It is the middlemen who negotiate with the drug companies about the prices that the insurers will pay for the drugs and what they will cover. Thus, the usefulness of a tool is compromised when key MFPs are not included in the lists.
For example, a drug pricing tool sold by Surescripts, based in Arlington, Virginia, which is partly owned by CVS Caremark and Express Scripts, includes data from these companies, but not OptumRx, a PBM owned by United States. And the OptumRX drug pricing tool includes Optum data but not those of Express Scripts and CVS.
Demetrios Kouzoukas, who runs the Medicare for CMS program, said he hopes the program's new mandate will encourage the industry to provide doctors and patients with a pricing tool, regardless of their insurance.
"What we hope and expect is that a standard will be developed by industry (…) so that this tool is available in all electronic health records, for all physicians and all patients, and that it is spreading even beyond Medicare, "he said. McSally at the hearing.
Given the competitive nature of the sector, some industry leaders do not seem to cooperate.
"I see no hope that there will be a centralized system that will link all plans / PBMs to all currently used EHR systems," said Thomas Borzilleri, CEO of InteliSys Health, a technology company. the health. based in San Diego.
However, the National Prescription Drug Program Council, a non-profit group that helps set guidelines for the pharmacy sector, is working on standards for a drug pricing tool. John Klimek, Executive Vice President, anticipates that by next year, physicians across the country will be able to use the same drug pricing tool to badess the cost of drugs for their patients, regardless of the insurer.
Even in the absence of such a standard, doctors and hospitals are encouraged to use the tool beyond the mere offering of cost-effective services to their patients: this can also save money. Money to suppliers.
For example, Allina, which owns or operates a dozen hospitals and dozens of clinics in Minnesota and Wisconsin, receives a fixed fee from some insurers to meet all of the health needs of patients. Thus, physicians and the health care system benefit when they can reduce costs and improve patient adherence to medication, said Dr. David Ingham, a family physician who also Edina, one of Allina's 600 primary care physicians using the tool.
"When we prescribe a more expensive drug, we share less income from the insurance contract," he said.
For example, he noted that the tool had helped prescribe inhalers to asthmatic patients.
"I took a medication that I normally use, and it was said that it would cost $ 240, but an equivalent alternative to $ 20 was pharmacologically equivalent. I sheepishly asked the patient which one we had to choose, "he said.
Dr. Norman Rosen, a family doctor based in Orange California and employed by the Providence St. Joseph Health System, is one of 800 hospital doctors testing the drug pricing tool. Blue Shield of California drugs this year. Based on the initial months of use, the tool should allow patients to save more than $ 100,000 in out-of-pocket fees this year, according to the companies.
Without this tool, Rosen said, it would be impossible for him to quickly know which drugs are covered by which insurers and which are the copays. He said that he had already allowed patients to save several thousand dollars a year by altering their blood pressure and their diabetes medications.
"It does not take much time, and it can be an important intervention because one of the fears we have is a patient who is not taking his medication because it is too expensive," said Rosen.
[ad_2]
Source link
