Millions of Americans are bedeviled by expensive medications. Your physician prescribes a new pill – for your diabetes or your migraines – and when you pick it up at the pharmacy, you are shocked at your out of pocket costs. Sometimes, there is no avoiding those costs. Perhaps your insurance only covers what it covers and there are no less expensive (and equally effective) alternatives. But many other times, your doctor could have prescribed something less expensive, perhaps a medicine your particular insurer covers more generously.
If only your doctor knew about this alternative at the time she prescribed it!
But how can she? One insurer might charge you less for drug X than drug Y, because the insurer gets that medicine at a lower price. However, another insurer might charge less for Y than X, because it gets that other drug for a better price.
How is a physician supposed to know which medicine is most affordable under which insurance plan?
Fortunately, there are tools coming into use designed to help clinicians figure out patient-specific costs of any medication they prescribe. The tools (jargon alert!) are called RTBTs, for real-time benefit tools. Embedded within the electronic medical record, the tools shoot electrons towards your insurance company (or at least that’s how I imagine they work), asking the company how much a particular medicine will cost a specific patient at a given time, knowing that the patient is enrolled in, say, the North Carolina Gold 100 plan. Better yet, some RTBTs will suggest alternative medications, when those alternatives will save the patient (and presumably the insurer) money.
These kind of tools could potentially save all of us a lot of money. In one study, Sunita Desai, a professor at NYU and one of the country’s leading experts on RTBTs, estimated that the tool reduced out of pocket costs by 11% for the average patient.
They reduced costs two ways: either by pointing clinicians toward alternative medications or by nudging patients to obtain their medications through the mail, where they can get the medicines more affordably.
Here is a picture of Desai’s finding, from a study published in JAMA Internal Medicine. The top square in the figure shows the 11% savings I mentioned above. Around the middle of the picture, there is a square off to the left. That square shows that, for people taking particularly expensive medications saved around 40% on their out-of-pocket costs when their doctors had access to RTBTs:
Out-of-Pocket Savings with Availability of Electronic Pricing Tool
Next time you get a new medicine, or get a refill for an expensive medication, ask your doctor if their computer can estimate your out-of-pocket costs. If you do that, you might be able to save a lot of money.
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