Bullets and bullets superimposed on a dollar sign, US, 1978. (Photo by Alfred Gescheidt/Getty Images)
Millions of Americans are troubled by expensive medicines. Your doctor prescribes a new pill – for your diabetes or your migraine – and when you pick it up at the pharmacy, you’re shocked by the out-of-pocket cost. Sometimes, those costs can’t be avoided. Perhaps your insurance only covers what it covers and there are no less expensive (and equally effective) options. But other times, your doctor may prescribe something less expensive, perhaps one that your particular insurer covers more generously.
If only your doctor had known about this option when he prescribed it!
But how can she? An insurer may charge you less for drug X than for drug Y, because the insurer gets that drug at a lower price. However, another insurer may charge less for Y than for Other Medicine at better price.
How does a doctor know which medicine is cheapest under which insurance plan?
Fortunately, there are tools coming into use that are designed to help physicians find out the patient-specific costs of any drug they prescribe. The tool (jargon alert!) for real-time leverage tools is called RTBT. Embedded within electronic medical records, the devices shoot electrons toward your insurance company (or at least that’s how I imagine they work), asking the company what the price of a particular drug would be at a certain point in time. How much a specific patient will pay, knowing that the patient is, let’s say, enrolled in the North Carolina Gold 100 plan. Even better, some RTBTs will suggest alternative medications when those alternatives will save the patient (and possibly the insurer) money.
These types of devices can potentially save us all a lot of money. In one study, Sunita Desai, a professor at NYU and one of the country’s leading experts on RTBT, estimated that the device reduced out-of-pocket costs for the average patient by 11%.
They reduced costs in two ways: either by pointing physicians to alternative medications or by encouraging patients to receive their medications through the mail, where they could obtain the medications more affordably.
Here’s a photo of Desai’s findings, from a study published in JAMA Internal Medicine. The top square in the picture represents the 11% savings I mentioned above. There is a square in the middle left of the picture. That section shows that, especially for people taking expensive medications, they save about 40% on their out-of-pocket costs when their doctors have access to RTBT:
Out-of-pocket savings with the availability of electronic pricing tools
Out-of-pocket savings with the availability of electronic pricing tools
The next time you take a new medication, or get a refill on an expensive medication, ask your doctor if their computer can estimate your out-of-pocket cost. If you do this, you may be able to save a lot of money.
