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PrimeRx Helps Manage Patient Medication Costs – which Reduces Prescription Abandonment
Introduction
A funny thing happened when the U.S. Congress, through the Inflation Reduction Act (IRA), capped out-of-pocket costs for Medicare patients: Fewer prescriptions were abandoned, resulting in more patients obtaining needed medications.
Analysis by IQVIA looked at the effect the cap had with regard to patient spending on antidiabetics and oncology drugs. The study found a significant improvement among Medicare patients, as abandonment rates for antidiabetics improved by 11%, and by 17% for oncology drugs.
As this example makes clear, medication affordability is a key factor in prescription abandonment. A few additional IQVIA findings include:
- More than 98 million prescriptions for new therapies were abandoned during 2023, due in part to high costs.
- More than half of prescriptions written for “recently launched medications” went unfilled due to high costs and payer control.
- While abandonment rates are less than 5% for prescriptions with no out-of-pocket costs, the rate jumps to 45% when the cost is more than $15, and 60% when patient costs exceed $500.
Overall, estimates of prescription abandonment range from 9% -11%. One survey though, conducted by GoodRx, found that 33% of Americans had a prescription sent to a pharmacy that was not filled. The GoodRx researchers extrapolated that finding to determine that “52 million Americans leave their prescriptions at the pharmacy every month.”
When asked why patients failed to fill their prescriptions, GoodRx found cost topped the list. Findings include:
- Medication was too expensive — 29%.
- Forgot to pick it up — 17%.
- Unable to get to the pharmacy — 17%.
- Medication was out of stock — 16%.
The story of prescription abandonment is one pharmacists know well. And too often, it’s a story without a happy ending: The affected patient goes without needed medication and the pharmacy misses out on a dispensing opportunity.
PrimeRx Pharmacy Ecosystem: All-In-One Platform that Elevates Pharmacy Efficiency
With PrimeRx though, the ending becomes much brighter. With more than 30 years of experience developing pharmacy-based technology solutions, PrimeRx has become the leading choice for pharmacies looking for innovative software solutions that truly address current pharmacy needs. This includes the iconic PrimeRx Enterprise system, which serves as the “nucleus” of today’s busy pharmacy, and offers the highest levels of workflow automation, patient management, and recordkeeping. The PrimeRx Cloud platform provides the same core functionality but accommodates pharmacy needs for added flexibility and accessibility. As the industry’s first comprehensive software-as-a-service (SaaS) solution, PrimeRx Cloud allows seamless access from anywhere.
With PrimeRx leading the way, pharmacists can access multiple capabilities for addressing medication affordability, helping to ensure patients leave the pharmacy with their medications. Beyond affordability, PrimeRx addresses other reasons for abandonment, with solutions for medication procurement, patient communication, and pharmacy access. Following is an overview of those capabilities.
Medication Affordability
- Real-Time Prescription Benefit by Surescripts. The Real-Time Prescription Benefit solution from Surescripts provides pharmacists with patient-specific information about drug coverage and pricing. PrimeRx pharmacies can integrate directly with this important solution for immediate access to benefits that include:
- Real-time access to medications covered by patients’ plan formularies. This allows the pharmacist to know immediately if a prescribed medication is covered, and what a patient’s out-of-pocket costs will be.
- List of covered alternatives. If a prescribed medication is not included on a patient’s formulary, or if the out-of-pocket costs are excessive, the solution will provide a list of as many as five alternative medications.
- Prior authorizations. If a prescribed medication requires a prior authorization, the solution will try to offer an appropriate alternative that does not require this time-consuming extra step.
The Surescripts solution is an effective tool in helping to address medication accessibility and affordability. The solution has been embraced by insurance plans accounting for more than 242 million patients. This means the Surescripts solution can access plan information for almost 82% of the total U.S. population.
Medication Synchronization. Patient records can be quickly adjusted so that all refills are set for the same day. Allowing patients to obtain all medications during a single trip to the pharmacy – making the process as easy as possible — has proven to be an effective tool in improving medication adherence.
eVoucher services which locate and apply manufacturer co-pay discounts at point-of-sale, enabling patients immediate relief from out-of-pocket costs.
Denial conversion capabilities allow a pharmacist to provide a patient with a prescribed medication, even if the drug has been rejected by a payer. The rejected claim is converted to “paid” status, thereby allowing the patient to receive the medication. Pharmacies are reimbursed for the cost of the medication and also receive an administrative fee to cover time and processing costs.
Communication
SMS/Email Capabilities.
PrimeRx will automatically generate a text or email to alert a patient when a refill is due. Once the patient confirms the request, the system will again generate a notice when the prescription is ready for pickup. Should a prescription remain in the bin, PrimeRx can send out intermittent “gentle” reminders.
Medication Adherence Reminders.
In addition to alerting the patient about scheduled refills and pickups, PrimeRx can automatically generate timely reminders with dosage instructions and other medication-related information. Messages can also include the pharmacy’s address and hours of operations, as a way to facilitate the process. Pharmacies can easily customize the frequency and content of patient messages. This important task can be accomplished quickly, usually with just a few keystrokes.
Pharmacy Access
PrimeRx CLOUD. As mentioned above, the PrimeRx Cloud platform addresses pharmacists’ needs for flexibility in servicing patients. Pharmacists can access the system from any internet-enabled device with a browser installed. This means, for example, that pharmacy staff can access the system while tending to a wheelchair-bound patient in the waiting area, or while off-site at a health clinic. PrimeRx Cloud essentially allows the pharmacy to move to where patients are located. This makes it easier for patients to obtain their medication, thus decreasing the risk of a prescription being left behind in the pickup bin.
PrimeRx CLOUD. As mentioned above, the PrimeRx Cloud platform addresses pharmacists’ needs for flexibility in servicing patients. Pharmacists can access the system from any internet-enabled device with a browser installed. This means, for example, that pharmacy staff can access the system while tending to a wheelchair-bound patient in the waiting area, or while off-site at a health clinic. PrimeRx Cloud essentially allows the pharmacy to move to where patients are located. This makes it easier for patients to obtain their medication, thus decreasing the risk of a prescription being left behind in the pickup bin.
Pharmacy Access
PrimeRx MARKET. Pharmacies can locate hard to find drugs through the PrimeRx MARKET online marketplace. With PrimeRx MARKET, pharmacies have instantaneous access to brands, generics, OTCs, injectables and more from over 40 wholesalers, and the ability to check inventory and pricing in a matter of seconds. Pharmacies can determine if a hard-to-find medication is available, lock-in pricing, and submit an order.
The solution eliminates the need for pharmacy staff to spend valuable time manually checking each supplier’s inventory for a needed drug. Instead, the drug can be located in real-time, and an order submitted without having to leave the PrimeRx MARKET platform. This means a medication can arrive at the pharmacy as soon as the next business day, and be in a patient’s hands shortly after.
The GoodRx survey had several troubling findings, but perhaps none as eye-opening as the idea of 52 million Americans leaving their prescriptions at the pharmacy every month. This is problematic for many reasons, including of course the negative consequences that result when patients don’t take their medications as prescribed.
Prescription abandonment has long been a concern for the nation’s pharmacists, who often feel they have no options to offer patients who simply can’t afford their medications. Now though, with the technology-based capabilities of PrimeRx, pharmacies have a real opportunity to address medication affordability and take a positive step toward making prescription abandonment a thing of the past.
