Healthcare Dive reported June 12 on a collaboration between Epic and Humana to allow physicians to check patients’ pharmaceutical benefits in real-time before prescribing a specific drug.
It is anticipated that this will lower the total cost of care by improving adherence and providing patients and physicians with price information to choose lower-priced drugs when there are multiple clinically equivalent options available.
The article reports that “when prescribers use IntelligentRx and see the range of treatment options, they choose the most cost-effective treatment nearly 40% of the time, according to Humana. Humana also estimates that over half of its Medicare Advantage members receive care from a physician who uses Epic.”
There are a few takeaways:
1. Price transparency: The first principle articulated in HFMA’s Price Transparency Report is that “Price transparency should empower patients to make meaningful price comparisons prior to receiving care. It should also enable other care purchasers and referring clinicians to identify providers that offer the level of value sought by the care purchaser or the clinician and his or her patient.”
And this absolutely extends to pharmaceuticals. As a result, one of the HFMA Price Transparency taskforce recommendations was “referring clinicians should help patients make informed decisions about treatment plans that best fit the patient’s individual situation. They should also recognize the needs of price-sensitive patients, seeking to identify providers that offer the best price at the patient’s desired level of quality.”
Assuming IntelligentRx is integrated into the clinical workflow in a way that is unobtrusive and simple to use (e.g. returns all clinically equivalent options in one query), this is a great first step.
2. Population health: It will be interesting to see how this impacts the total cost of care for physicians participating in shared savings/risk contracts with Humana.
As the article points out, this should improve medication adherence for Humana members, which should decrease potentially preventable ED and inpatient utilization and increase shared savings. If this hypothesis is true, it will make Humana a more desirable partner for physicians interested in risk arrangements.
Humana also potentially has a bit of a natural experiment on its hands. It’s not hard to imagine that some physicians will use the IntelligentRx function more consistently than others. Comparing the risk-adjusted preventable ED and I/P utilization rates of physicians who use it versus those that don’t could tell us a lot about the ability of pharmaceutical price transparency to improve medication adherence and patient outcomes.
3. Social determinants of health: Obviously, prescribing medications that are more affordable for patients will improve one of the crucial social determinants of health (access to medications). However, simply having a conversation about therapy affordability will likely provide insights that can bring to the surface other SDOH that are impacting a patient’s outcomes and allow the physician to address those issues in care plans.