industry update

It’s Time to Get Real about Real-Time Benefit Checks

December 18, 2018

For years, industry experts have been discussing the promise of Real-Time Benefit Check (RTBC) services and the dynamic information that they would provide to HCPs and patients in the ePrescription workflow. In a nutshell, electronic RTBC services in the EHR would dynamically inform a prescriber about the exact cost of a prescription down to the patient level, based on formulary and the patient’s insurance plan coverage. These services, once implemented broadly, would essentially encourage and enable doctors to seek lower cost treatments when the cost of brand prescriptions is high.

But, for years it felt like a distant reality due to formidable implementation challenges. However, technical progress proceeded quicker than many anticipated and RTBC is now a reality.

Surescripts, the network hub that processes all electronic prescriptions in the US, has rolled out a Real-Time Prescription Benefit service that provides RTBC information to HCPs at the point of prescription. Adoption skyrocketed over the past year and now 77% of U.S. EHR companies have signed on to the service.

The effects are game-changing:
“CVS Health recently reported that its PBM members are saving an average of $130 per prescription fill when prescribers use Real-Time Prescription Benefit information and switch to a lower-cost therapeutic alternative. According to CVS Health, prescribers using Real-Time Prescription Benefit are switching to a covered drug 75 percent of the time when the originally-prescribed drug is not on the member’s formulary. In instances where the original drug is covered, but a lower-cost clinically appropriate brand or generic alternative is available, prescribers are switching patients to a lower-cost alternative 40 percent of the time.”

What does this mean for marketers and their brands? Prescription products will now have their costs revealed clearly and plainly in the EHR at the moment when a prescriber is preparing to complete an ePrescription, and additional options will allow the prescriber to identify lower-priced options. The services may serve as a type of “counter-detail” for branded products, as doctors are already increasingly conscious about price and the effects of financial burden on their patients. Due to these services, the pressure on MDs to switch to lower-cost products, and generics, will increase.

Thus, embedding electronic co-pay and voucher support for commercial patients is becoming more important than ever. Heartbeat partners with EHR aggregators that can seamlessly embed a brand’s co-pay/voucher into the eRx workflow, displaying the patient financial support offered by the brand clearly to the doctor. Services like these can help a doctor understand what the net cost will be to the patient, and potentially help dissuade them from switching to a lower-cost alternative, assuming their clinical decision favors the brand product. In venues where EHR aggregators are challenged to achieve high reach (e.g. in hospital settings and in EHRs that don’t support them), Heartbeat provides a suite of programs that can be embedded into EHRs as customizations at the practice level, empowering brands to achieve high reach in all practice settings and across all disease categories.

In short, the proliferation of Real Time Benefit Check services place cost front and center of treatment consideration. Pharma brands must ensure they aren’t left out of the discussion—before it even begins. To explore your options and to learn more about how your brand will be impacted, drop a line to Hudson Plumb, SVP of EHR & Outcomes Optimization at Heartbeat.