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Improve member experience with real-time benefit tools and drug price transparency

Michael S. Adelberg (michael.adelberg@faegredrinker.com) is Principal at Faegre Drinker Consulting in Washington, DC. Jeffrey A. Lewis (jalewis@rxss.com) is Director of Compliance at Rx Savings Solution in Overland Park, KS.

With nearly half of all Americans using prescription drugs[1] and drug costs rising at a rate exceeding national inflation,[2] vulnerable Americans are made more vulnerable by high drug costs. Most of the time, patients do not know the cost of their drugs until they are charged at the drug counter. Several studies document that patients are prone to abandon their prescriptions[3] or underdose themselves in order to have money for other important expenses, such as food and rent. In 2019 alone, Americans collectively paid $67 billion out of pocket for prescription medications,[4] with 45% of people abandoning their scripts when out-of-pocket costs exceeded $125. Unfilled prescriptions and patient underdosing are not only dangerous to patients—they create considerable compliance risks for providers and health plans.

As out-of-pocket expenses increase, medication adherence decreases, especially for those on multiple medications and of lower socioeconomic status.[5] The long-term benefits of medication adherence—improved clinical outcomes and decreased costs—are blunted when drug affordability trumps drug adherence. Unfortunately, providers who prescribe medications rarely have drug cost information to consider when prescribing, and the pharmacist who sees the cost rarely has the ability to easily change the prescription to a therapeutic equivalent.

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