Prime Therapeutics introduces Real Time Benefit Check solution with DrFirst

Technology enables informed prescribing and aims to enhance member experience within clinicians’ workflows

September 2, 2020
EAGAN, Minn. – Prime Therapeutics LLC (Prime) is rolling out Real Time Benefit Check starting with myBenefitCheck from health care technology pioneer DrFirst, giving health care providers comprehensive information so they can easily prescribe the most appropriate and cost-effective medications at the point of care. Real Time Benefit Check allows prescribers to answer patients’ questions about drug coverage, aiming to streamline medication prescribing, and eliminate surprise costs for members at the pharmacy.

This innovation is Prime’s most recent offering to drive affordability for clients while seeking to improve member experience and outcomes.

Real Time Benefit Check works through the ePrescribe function of a health care provider’s electronic health record (EHR) system, delivering essential medication and benefits information within the prescribing workflow. The solution shows more than just a drug’s price. Populated with an individual member’s benefit data, the tool will alert prescribers when a chosen drug might add steps, time, and cost to the prescription filling process.

The tool also displays lower-cost and therapeutically-equivalent alternatives to any chosen drug, as well as a breakdown of patient-specific costs based on the member’s health plan formulary. In addition, Real Time Benefit Check shows if a drug requires prior authorization. This allows providers and patients to discuss options at the point of care and seeks to speed time to treatment, drive medication adherence, and deliver a more convenient, less time-consuming process for clinicians.

Prime’s Real Time Benefit Check offering was built on the foundation of a rigorous pilot using multiple vendors, including DrFirst. After testing for 14 months, processing 700,000 transactions among 25,000 prescribers, results showed an average annual savings of $692 for each prescription that was changed as a result of using the tool. One Blue Plan in the pilot realized a total estimated savings due to alternate drug choices of $348,000 from April 2019 to March 2020. This data supports the idea that increased prescriber engagement may generate significant prescription savings for the member and payer.

“Prime’s Real Time Benefit Check is a game-changer for providers and patients,” said Christine Bent, senior vice president and chief operating officer for Prime. “Providers need efficiencies in their daily workflow and today’s consumer expects real-time, personalized services in health care on par with other industries like retail or banking. Real Time Benefit Check is designed to get more affordable drugs approved faster, helping to reduce surprise costs and interruptions in care.”

Prime’s Real Time Benefit Check will fulfill the Centers for Medicare & Medicaid Services (CMS) rule requiring insurers that offer Medicare Part D health benefits to use an electronic drug cost and health benefit comparison tool that’s compatible with at least one electronic health records (EHR) system, and goes a step further by applying it to commercial members.

DrFirst was the first in the industry to provide price transparency to health care providers and has processed more than 100 million transactions to date. The company partners with more than 260 EHRs including the country’s largest vendors. Together with its e-prescribing tools and pharmacy benefits management (PBM) integrations, DrFirst reaches 90% of covered lives to make price transparency available to providers nationwide. Prime contracts with additional vendors to provide coverage to other EHRs.

“With prescription drug prices rising at every turn, patients need price transparency and the ability to discuss options with their doctors during office visits,” said G. Cameron Deemer, president of DrFirst. “Providing this information based on individuals’ health insurance benefits and formulary, in real-time at the point of care, allows patients to more fully participate in their health care decisions, so they are more likely to adhere to their treatment plans.”

DrFirst’s myBenefitCheck is live with Prime’s Real Time Benefit Check for select Blue Plans. Other Real Time Benefit Check integrations will be implemented in October for select Medicare Part D clients. A rollout to commercial clients will follow.

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