Consumers are demanding transparency in the prices of drugs. Here’s how they are getting it.
More companies are turning to price transparency tools to help members make the smartest decisions about their medications. “Drug pricing tools have the potential to help employees and their organizations significantly reduce their prescription drug costs, while helping those without insurance find the lowest costs between different pharmacies and to take advantage of coupons and discounts,” says Marcia Otto, vice president, pricing and transparency applications at Health Advocate, a national health advocacy, patient advocacy and assistance company.
Here’s an in-depth look at three popular online price transparency tools, sponsored by pharmacy benefits managers (PBMs) and other organizations:
BatesRick Bates, CEO/cofounder of SingleCare, an online retail marketplace that helps users compare prices for a wide range of healthcare services including medications, says consumer-driven healthcare is the impetus behind online pricing marketplaces like his. Consumers are concerned about coverage limits, costs, and access, he says.
Launched in early 2016, the tool is available in Arizona, Maryland, Virginia, Washington, D.C., and Pennsylvania, totaling 750,000 members.
Members can use the site to view prices for prescription offerings at major pharmacies including Walmart, CVS, Walgreens, Rite Aid and Kroger, by specific location.
Bates says the site includes all drugs that can be dispensed at a regular pharmacy, excluding specialty medications. If a request is for a branded drug, the site will provide information on an equivalent generic and its price.
“It’s important to publish drug prices because they might be lower outside of insurance coverage if a member has not hit a deductible yet,” he says. “This is the only way consumers can truly understand the competitive market price for a specific drug; otherwise plan members become a captive audience.”
Prices found on the SingleCare site vary depending on the pharmacy and whether a transaction is cash-based or through insurance with copayments or deductibles.
Castlight Health introduced its prescription drug comparison tool to employer groups in 2013-not unlike SingleCare but with some bells and whistles. “Our core objective is to help employees make better decisions using information on our site or through their mobile devices,” says Will Bondurant, director of product marketing for Castlight.
In addition to comparing prices, users can also:
The tool also compares prices based on whether consumers have copayments or pay coinsurance, purchase at retail or through home delivery, use a discount card, or have pharmacy services that overlap with a medical benefit.
Bondurant says the site also provides contextual information about each drug from Consumer Reports, and educational content from physicians and insurers, including side effects, medication alternatives and appropriate use.
Fifty-one percent of eligible members have used information on from Castlight over the year, including all offerings-pharmacy, medical and dental services.
Bondurant identifies two primary groups of users:
Next: Express Scripts
The country’s largest PBM has an online price transparency tool on its website and via mobile devices. The product provides drug prices along with retail and home delivery alternatives based on a member’s location.
Unlike the other tools, members can refill prescriptions through the app. For new drugs, they only can price the medication. Then, a physician needs to submit a prescription via e-prescribing or by phone, or a member can mail the script request to a pharmacy.
The PBM also offers My Rx Choices, which provides less-expensive generic alternatives and branded drugs when a member inputs a brand name.
CavanaughExpress Scripts also provides clinical information on each drug based on a member’s profile-side effects; drug-drug, drug-OTC and drug-allergy interactions; information based on age, gender and medical conditions; administration; and dosing.
Brian Cavanaugh, senior director, home delivery product management for Express Scripts, says that when the PBM surveyed members about information they most desired, it was potential side effects.
Users can also input how they take their medications-whether it be once a day for 90 days, a rather straightforward prescription, or two inhalers a month rather than one-so that they can see exactly how much they should expect to pay.
“We believe our patients absolutely must have full transparency as to what a drug will cost them and if there are opportunities to decrease that cost,” says David Whitrap, Express Scripts spokesperson.
The website and mobile app prompt members with additional savings opportunities based on their specific benefit designs, such as using a less expensive, clinically equivalent alternative or dispensing a medication at a more affordable retail pharmacy.
Similar to SingleCare, Express Scripts’ members can take advantage of a lower cost if a pharmacy offers patients a “usual and customary” cost of a drug that might be less than the price available with a plan’s copayment and still achieve the benefit of Express Script’s clinical safety review of the medication.
Mari Edlin is a frequent contributor to Managed Healthcare Executive. She is based in Sonoma, California.