Speakers at AMCP 2023 discussed strategies payers can use to promote provider adoption of real-time benefit check (RTBC) tools, strengthen trust between stakeholders, and improve patient access to lower-cost medications.

In a 2022 Medication Access Report by CoverMyMeds, 78% of surveyed patients said costs were greater than expected when they went to pharmacies to pick up their medications. From 2020 to 2021, patients increasingly sacrificed medications (36% vs 51%) and essentials (43% vs 52%) or modified their treatments (41% vs 56%) due to costs, said Michael Burger, senior consultant, Point-of-Care Partners, LLC.

“As a health plan, that’s concerning because we want and need our members to be on the right medications,” said Rick Jennejahn, director of pharmacy innovation programs, Excellus BCBS, Pharmacy Solutions. 

National data also show that when patients chose a lower-cost alternative in 2021, average savings per prescription were:

• $51 for anti-depressants;
• $27 for anti-hypertensives;
• $32 for cholesterol-lowering drugs;
• $116 for diabetic therapies; and 
• $26 for peptic-ulcer therapies.

Raising provider awareness and utilization of RTBC can provide clinical value, lower cost expectations, enhance provider satisfaction, and improve the patient experience, Mr Jannejahn said.

“It’s complicated today. Just getting an appointment sometimes can be a challenge. Real-time benefit check can help in terms of making sure patients can get on their treatment quickly,” Mr Jennejahn said.

All electronic health records (EHRs) have RTBC tools built in, but the challenge is ensuring providers and patients use them, Mr Burger said.

“There’s a pretty big disconnect between the number of providers that have the information and the number of providers that believe they have out-of-pocket costs. It’s a challenge all the way around, for the PBMs, for the providers, for the patients, that this information is available but isn’t being widely used,” Mr Burger said.

Excellus Health Plan implemented RTBC in 2019. Excellus provides pharmacy benefits to 1.4 million members enrolled in both public and private plans in New York. Excellus has approximately 37,000 in-network providers, and between 70,000 and 100,000 prescriptions are filled daily, Mr Jennejahn said.

Throughout 2020, provider adoption of RTBC was slow, complaints mounted, and reporting was limited due to the pandemic, Mr Jennejahn said. 

Providers said RTBC added to the complexity of their workflow, as they were required to use multiple systems, networks, and portals, which sometimes had slow response times or data lags, Mr Jennejahn said. There were also gaps in knowledge, as providers and their staff lacked awareness about RTBC tools and how to use them. Additionally, the information provided through RTBC tools was not always actionable or accurate.

In turn, the health plan could not always assist providers due to multiple EHRs being used across the service area, limited visibility into the RTBC tool’s functionality, and limited data utilization, Mr Jennejahn said.

Excellus sought to improve RTBC adoption through increased provider outreach, Mr Jennejahn said.

“We’re engaging with our health systems [and] our provider partners who are not using real-time benefit check and trying to get their questions answered and get them on board,” Mr Jennejahn said.

Excellus developed a training curriculum for the tool, reference material for top EHRs on how to activate and use RTBC, and a “help desk” to address any questions.

“We focused a lot on messaging. We can talk about all these things that are for the betterment of mankind, and that’s great, but the providers and patients are all about, ‘What’s in it for me?’” Mr Burger said.

He recommended emphasizing how, through using RTBC tools, providers can improve patient trust and rapport; speed access to therapy; increase patient adherence; and decrease administrative burden. 

For patients, RTBC can reduce delays due to prior authorization; ensure patients are fully informed; reduce surprising prices at the pharmacy; promote medications that balance cost and convenience, and more. 

“We think that if we can get more providers using real-time benefit check, if we can put these tools in their hands…we can help achieve [affordable access to care],” Mr Jennejahn said.