Surescripts is joining forces with five EHR companies (Allscripts, Aprima Medical Software, Cerner, Epic and GE Healthcare ) to provide Real-Time Prescription Benefit and Prior Authorization. Representing 53 percent of the U.S. physician base, the partnership will leverage information from pharmacy benefit managers (PBMs) CVS Health and Express Scripts, who represent nearly two-thirds of U.S. patients, to deliver patient-specific benefit and price information to providers in real time at the point of care. Once integrated with the EHR, the solution will also display therapeutic alternatives so that the prescriber and patient can collaborate in selecting a medication that is both clinically appropriate and affordable.
Surescripts Real-Time Prescription Benefit and Prior Authorization solutions require strong cross-market network alliances, which are already in place and expanding at an incredible rate. Surescripts prior authorization is currently available in EHRs representing 75 percent of U.S. physicians, and is connected to PBMs representing 85 percent of covered lives.
Prescription price transparency is critical to lowering patients’ out-of-pocket costs and preventing “sticker shock” and prescription abandonment at the pharmacy, a common cause of medication non-adherence which negatively impacts patient safety and costs an estimated $300 billion annually, according to the New England Health Institute. In just 12 months, Surescripts Real-Time Prescription Benefit pilot participants, including CVS and Express Scripts, generated 3.75 million transactions to test the functionality and validate the market demand for delivering patient-specific prescription benefit price data to prescribers in real time.
When used together, Surescripts Real-Time Prescription Benefit, Prior Authorization and E-Prescribing create the ideal scenario. For the first time ever, prescribers will be able to see what a medication will cost their patient, based on their specific health plan coverage, and pick the most affordable medication that meets the patient’s therapeutic need. Once the most appropriate and affordable medication is selected, if an authorization is still required, it may be quickly completed during the office visit within the EHR workflow. It is then sent to the pharmacy, resulting in the patient leaving the doctor’s office confident in both the medication choice and the medication cost, knowing that it will be covered by their insurance.
“Surescripts is leveraging the same network alliance we built to revolutionize healthcare with e-prescribing 17 years ago. Now, we’re deploying actionable intelligence to the exact point in the care process where patients’ prescription benefits can be optimized,” said Tom Skelton, Chief Executive Officer of Surescripts. “We’re once again at the forefront of a transformational moment in healthcare. Together with our partners, we’re delivering value back to the network in the form of greater price transparency and a streamlined workflow—two keys to patients getting the right drug at the right time, and at a cost that lets them start and stick with their medication therapy.”