Arrive Health, the leading provider of integrated solutions that improve patient affordability and access to care, has completed a comprehensive analysis of 78 million prescription transactions to understand the frequency at which a patient’s insurance provides full coverage for the medications being ordered on their behalf. The results show that 46.78% of the time, patients have an option that would cost $0.
Patient affordability is a pervasive, national issue. While the percentage of Americans covered under health insurance has reached more than 90%, having insurance no longer guarantees healthcare will be affordable. Unfortunately, even slight increases in patient copay can drastically reduce medication adherence, with non-adherence costing the US as much as $500 billion annually. Many patients even ration their medications – including life-saving therapies like insulin – due to costs.
Without transparency into real-time cost and coverage data, providers cannot discuss ability-to-pay or alternative medication options with their patients. Kyle Kiser, Chief Executive Officer of Arrive Health commented, “It is no longer possible to deliver quality care without considering cost, and there is a significant opportunity to inform providers about lowest-cost options when prescription decisions are being made.”
Data in the retrospective review included Real-Time Prescription Benefit (RTPB) transactions completed between electronic health record (EHR) prescribing workflows and pharmacy benefit manager (PBM) databases in Arrive Health’s nationwide network. In total, 78.26 million transactions completed by more than 300,000 providers across 2022 were analyzed.
Arrive Health identified 36.6 million transactions in which a $0 option was available for the pended medication – 46.78% of the total transactions completed. Pended medications are those medications that have been input into an EHR ordering workflow, prior to being sent to the pharmacy. Importantly, the analysis found that 10.6% of the time, the Arrive Health RTPB solution returned an alternative that would cost the patient $0 when the originally pended medication was greater than $0.
Providers using the Arrive Health solution were able to switch their patients to medications that had no cost. Examples include:
- A provider at a large integrated health system in Pennsylvania switched a patient’s prescription for a blood pressure medication to a similar alternative, bringing the patient cost from $86.98 to $0 per month.
- A provider at a regional health network in the Midwest switched a patient’s prescription from a patch to a tablet (while keeping the same active ingredient), reducing the patient’s monthly cost from $208.62 to $0.
- A provider at a fully-integrated academic medical center in North Carolina switched a patient’s asthma inhaler quantity from 1 inhaler to 3 inhalers, and switched from a pharmacy pick-up to a mail-order option, bringing the patient cost from $447.95 to $0.
Certain medication classes had more frequent opportunities to reduce patient costs. For example, HMG-CoA reductase inhibitors (statins) which control cholesterol levels, were pended a total of 2.83 million times in the analysis. 28.18% of the time, the pended medication had an associated cost, but the Arrive Health solution surfaced an alternative statin that cost the patient $0. Long acting and rapid acting insulins – which were pended 417,000 and 224,000 times respectively – both had $0 options available 47% of the time.
Medication cost data is often opaque and formulary complexities make it difficult to know which options are covered and what alternatives may be available. The result is patients being prescribed medications that are not the most affordable option.
Integrated technology is required to surface pricing and lower-cost option availability at the moment prescription decisions are being made. By leveraging a robust network of health systems, health plans, PBMs, and EHR partners, Arrive Health surfaces low-cost – even zero-cost – options in real-time, ensuring patients get the care they need at prices they can afford.