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CARIN Alliance Workgroup to Help Advance Real-Time Pharmacy Benefit Check for Patients

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By Pooja Babbrah, Practice Lead, PBM Services 

Population Health Management

RTPBC will help patients better understand their out-of-pocket costs for medications before they reach the pharmacy

The CARIN Alliance—a large, multi-stakeholder coalition–has formed a workgroup aimed at advancing the consumer-facing, real-time pharmacy benefit check (RTPBC). The goal is to give patients personalized drug pricing information at their fingertips through the RTPBC. This in turn will help patients better understand their out-of-pocket costs for medications before they reach the pharmacy and improve engagement in their care. I am pleased to be serving as a subject-matter expert on the workgroup.

The RTPBC builds on progress to date concerning important prescription cost and coverage information available at the point of prescribing. The RTPBC is essentially a response to prescriber challenges with benefit information. It advances price transparency, but has additional, far-reaching value. Development of the RTPBC represents a beginning of the end of the decades-long disconnect in drug costs for patients. It will take a while to fully realize the benefits of integrating this transaction into electronic prescribing (ePrescribing). However, there is a huge potential on the horizon to improve the patient’s experience and avoid cost-related disruptions in care.

The RTPBC will use application programming interfaces (APIs) — to enable consumers to look up the costs of their prescriptions, as well as what their insurance will cover and pay for, on a smart phone, tablet or other electronic device. This has been a black box for most people. The goal for a consumer-facing RTPBC is to allow a patient to get the cash price for a medication and apply the costs of coupons and other kinds of financial assistance, as well as indicate whether prior authorization (PA) is needed, which can also be a barrier to access. While some of this information may be available through payer portals, consumers may not know about this resource or how to access it.

The workgroup held its first meeting in November 2018. Several meetings have been held since then, with the next on May 10. A subgroup has been formed, which has identified with the first use case designed to allow a patient to look up benefit information as well as the cash price for a prescription that has been written by their provider.

The workgroup will be working with the standards development organizations, Health Level Seven International (HL7) and the National Council for Prescription Drug Programs (NCPDP) to develop implementation guides for member organizations who are interested in implementing a patient-facing RTPBC.

The workgroup’s efforts will align with the newly issued proposed regulation on interoperability and information blocking from the Office of the National Coordinator for Health Information Technology and the new proposal on making patient data available  through APIs from the Centers for Medicare and Medicaid Services. (Read our take on these important, draft rules.)

Point-of-Care Partners is working closely with the CARIN Alliance to advance consumer-facing RTPBC. Want to know more or join the Workgroup? Reach out to me at pooja.babbrah@pocp.com.

Pooja Babbrah

Pooja Babbrah

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