We all know it — healthcare is often hard to navigate. Even in the 21st century, unfortunately our delivery system remains too siloed in a complex mix of multiple providers and venues, insurance plans, electronic record systems that often don’t share information well, if at all, and discount programs that may or may not be of any real assistance in both providers’ and patients’ quest for value.
In this environment, care coordination that leads to the best-possible clinical and financial outcomes with the least amount of delay and hassle is indeed a huge challenge. It’s a very real part of the reason why RxLive exists.
Who’s prescribing…and who’s keeping track?
Today, people can receive care in a wide range of venues — from primary care and specialty practices to urgent care centers and walk-in clinics, Emergency Departments, on-demand telehealth services, employer-sponsored health and wellness centers, alternative medicine providers and others. The list keeps growing. Again, too few have the ability to efficiently and securely share patient-centered data across pertinent providers’ health records…that is, for the venues that even have them.
When you layer in the fact that most of these venues can prescribe medications, the question becomes, “Who has the full information to ensure the patient is taking the most appropriate medications?” The question that also should run parallel to clinical safety and effectiveness is, “Who’s providing information on how to best pay for the meds?” Here, too, there are options…and ramifications.
To GoodRx or not to GoodRx?
In our patient consults, RxLive clinical pharmacists are often asked about discount programs such as GoodRx. There are more, and now Amazon is getting into the dispensing business. So how do providers know what to recommend, and patients how to decide which option to use, and why?
With increasing frequency, they’re turning to the experts in comprehensive medication management — clinical pharmacists.
As an example, some primary-care practices have been moving towards a patient-centered medical home approach, or PCMH for short. They recognize the complexity of healthcare delivery, and the PCMH model aligns with their commitment to deliver patient care in a more holistic way. In this environment, they’re turning to the clinical pharmacist to sit at the nexus of managing the significant percentage of care delivery that involves medications. The clinical pharmacist becomes, if you will, a knowledgeable “traffic cop” to manage the multiple prescriptions and medication advice that’s often coming from all directions. These forward-thinking providers recognize that since so many healthcare services involve medications — meds that can improve patient health outcomes and reduce costs — pharmacists are the experts best positioned to review a patient’s medication regimen and history to determine if there are opportunities to make adjustments to simplify (read: stop unnecessary meds) and reduce the cost of their meds.
That perfectly aligns with our goal at RxLive: to reduce healthcare expenditures responsibly while keeping the patient’s best interest at heart. Because we don’t dispense any medications, we’re able to approach medication management and cost management from a completely unbiased perspective.
Back to GoodRx et al. — One of the most frequent suggestions I get from providers is to give patients a GoodRx coupon card (or a similar coupon). Certainly, there are instances where it can offer patients significant savings, at least in the immediate-term. But here’s why it’s not always the best solution.
What many people don’t fully understand (and there are so many reasons why it’s clear as mud) is that when you opt to use a coupon such as GoodRx, a pharmacy savings club or cash pay, the amount you pay isn’t counted by your insurer towards your annual out-of-pocket costs. This means that while you’re paying less now for the medication, you’re not “getting credit for it” with your insurance plan and thus towards your annual deductible.
This is relevant because more and more people are opting for high-deductible medical and prescription insurance plans. So skipping putting those pharmacy expenses towards your deductible today can have significant negative financial consequences in the long run.
No record — Another difficulty when using cash pay or coupons is that the dispensing of the medication won’t be recorded in your electronic record with the insurance company. So your doctors and care team can’t know if you’ve gotten the medication. Many practices’ EHRs have the capability to receive and log this information provided by the insurance company.
Misaligned incentives contribute to higher prices — With Amazon entering the world of dispensing prescriptions and offering to check if the medication is more affordable using their coupon/cash pricing vs. insurance, this may drive more people to select the coupon option. The Catch-22 is that this effectively incentivizes insurers to continue raising prices, so that consumers opt not to use their paid-for benefits. That way, the insurer doesn’t have to pay for the medication at all. The insurer’s reduced cost is far more likely to be reflected in their bottom line, stock dividends and executive bonuses than it is in lower insurance prices for you. Like too often across healthcare, the pharmaceutical market is rife with misaligned incentives.
Another example: All pharmacies — whether retail, mail-order or insurance-company-owned — have a number of incentives to refill patient’s medications as often as possible, without regard to whether or not the medication is needed. This adds millions of dollars in waste to the healthcare system every year.
Deprescribing — As a clinical pharmacist, one of my passions is to facilitate deprescribing. When a medication has no current clinical indication, it should be stopped. That’s our commitment to optimal health, clinical safety, patient satisfaction, and financial savings.
Your long-term medication financial planner
RxLive’s highly experienced clinical team uses our cloud-based clinical software to provide the best medication management possible. That includes artificial intelligence (AI) and machine learning to further help them review the best possible financial options available. In this way, we serve as a long-term medication financial planner for our patients, and for our provider partners entrusted with their care.
We achieve this by educating patients and providers on the competing incentives in the pharmaceutical industry and how they impact each patient’s wellbeing, both clinically and financially.
I’ll close by providing you this link to a brief Zoom interview with one of our customers, Edy Mollé of New York State. Edy discusses how her consult with one of our pharmacists helped “make a huge difference” in her life by discovering duplicate prescriptions, and how she saves so much money by discontinuing OTC meds that, in our discussion, she realized weren’t really helping her.
Thanks, Edy, for the kind words, and for those from other customers we’ve talked with (some posted on our YouTube channel) about their RxLive experience in positively impacting their clinical and financial health. It’s what we’re here for.