Real-Time Pharmacy Benefit Check: The Payer Value Proposition

Results of interviews with and information from payers representing 95% of commercially covered lives

Interest is growing in electronic prescribing innovation as a mechanism for increasing transparency of drug information for providers and their patients. Two transactions, electronic prior authorization (ePA) and Real-Time Pharmacy Benefit Check (RTPBC), when used together, deliver more accurate information about coverage and costs of drugs at the point of prescribing and allow physicians to help their patients get on therapy faster.

Adoption of ePA has lagged due to multiple potential points of failure during the ePrescribing process. These deficiencies, along with inaccuracies in the Formulary and Benefit (F&B) file, led to the introduction of RTPBC.

The industry has increased its focus on and investment in RTPBC, which led us to complete a comprehensive review of materials available on RTPBC and conduct interviews with payer executives to better understand the value of RTPBC. This report provides a summary of our qualitative research based on information from* and interviews with 6 of the top 10 PBMs, which cover 95% of commercially covered lives

*Publicly available presentations, reports and other sources were reviewed and considered alongside feedback gained in interviews.

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• November 9, 2018