Medication non-adherence adds more than $280 billion in avoidable costs to the U.S. healthcare system each year, with two of the leading causes related to the patient's prescription out-of-pocket costs and a lack of transparency into plan prescription benefit information during the prescribing process.¹¸²

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When prescribing within their EHR, physicians do not have access to accurate or timely formulary information. This lack of information prohibits them from fully understanding whether a medication is covered under the patient's pharmacy benefit, whether a prior authorization is required or whether there is another potential barrier to the patient receiving the medication. It also inhibits physicians from having an informed discussion with their patient about their prescription out-of-pocket cost—a conversation that can have a dramatic impact on medication adherence.

Instead, only until the patient arrives at the pharmacy is the outcome of the prescription known. If the prescription cost is too onerous, if a prior authorization is required or if the product is not covered under their prescription benefit plan, a series of inefficient activities ensues, typically with the pharmacist or patient calling the physician's office to request a change. Worse yet, the patient may become frustrated and abandon the prescription altogether.

Real-time prescription coverage verification at the point of prescribing

RelayHealth's RxBenefit Clarity™ is a pharmacy benefit inquiry platform that provides physicians with patient, pharmacy and medication-specific prescription benefit information in real-time during the prescribing process. When the physician makes the appropriate drug selection within the EHR, RxBenefit Clarity will automatically return the patient's out-of-pocket costs and other applicable benefit information before the prescription is submitted—requiring no extra clicks or keystrokes from the prescriber.

With RxBenefit Clarity, the physician can see the same information a pharmacist sees when submitting a prescription to the health plan for real-time prescription benefit coverage verification. Delivering this vital information directly within the physician's workflow before the prescription is submitted can be a catalyst to dramatically improve medication adherence, enabling the physician to:

  • Communicate the patient pay amount for the prescription and make adjustments if needed
  • Identify and address prescription-fill barriers that may hinder pick up at the pharmacy (e.g. product not covered, prior authorization required, plan limit exceeded)
  • Initiate a conversation with the patient about prescription affordability and the importance of adherence to the prescribed medication
Benefits for physicians and staff:
  • Designed for higher office productivity (less disruption, fewer callbacks from pharmacy)
  • Accurate, real-time formulary information in EHR prescribing workflow
Benefits for pharmacies:
  • Cleaner prescriptions for improved pharmacy staff productivity
  • Opportunity for higher prescription fill rates and reduced restocks
Benefits for patients:
  • Increased opportunity for awareness of prescription benefit coverage
  • Improved patient medication adherence may lead to better health

¹Annals of Internal Medicine. “Interventions to Improve Adherence to Self-administered Medications for Chronic Diseases in the United States: A Systematic Review” December 4, 2012, Vol 157, No.11

²D.P. Goldman. “Pharmacy Benefits and the Use of Drugs by the Chronically Ill,” JAMA, May 2004.