On May 16, in an effort to help participants save on the cost of prescriptions, achieve price transparency at the point of care, and improve overall cost-effectiveness, the Centers for Medicare and Medicaid Services (CMS) announced that all Part D plan sponsors are required to implement at least one electronic Real Time Benefit Tool (RTBT) of their choosing by January 1, 2021.1
At SS&C Health we have a unique point of view on what this announcement means for stakeholders across the healthcare continuum. We were early entrants to the Real-Time Benefit (RTB) market. We developed, implemented, and then improved upon some of the first-ever versions of this tool, and we have seen how equipping prescribers with accurate comprehensive patient-centric formulary, benefit, channel and therapeutic alternative information can reduce out-of-pocket costs for patients and drug spend for plans. We believe that the new RTB requirement will support value across the industry and can contribute to better clinical and financial outcomes. Here are three reasons why:
RTB equips providers and patients to make better prescription decisions
RTB is among the most effective tool available for supporting out-of-pocket price transparency, which is especially important in today's consumer-driven environment. The current generation of RTB solutions equips providers with access to patient-specific formulary and benefit information as well as channel options, drug interactions, and therapeutic alternatives so they can work with their patients to prescribe the most affordable, effective, hassle-free medication. This is a big step in the right direction for price-conscious consumers and for pharmacies, providers, and health plans who want to deliver an excellent member experience and promote adherence.
RTB supports better quality ratings
RTB can help improve core performance indicators that affect quality ratings such as patient satisfaction, patient engagement by physicians, and retention of physicians and members.2 When the member's health journey does not get delayed or hard-stopped due to prior authorizations, step therapy, or cost concerns, they have a more positive experience, and that supports higher quality ratings.
RTB amplifies your value-based care efforts
RTB aligns well with Value-Based Care concepts because it gives providers and patients more control over a leading cause of medication nonadherence: cost3. When out-of-pocket costs are lower, we see better adherence, which leads to better financial and clinical outcomes4. This supports dollars saved for all stakeholders who are involved in value-based contracting.
While its potential as a time-saving, money-saving, satisfaction-driving tool is evident; RTB is still a relatively new solution in the marketplace. However, as Part D plans comply with the new rule, wide-spread adoption will drive even more progress when it comes to data analytics and future capabilities. Commercial plans will also reap the benefits of an accelerated learning curve. As RTB providers amass information and experience related to adherence, provider adoption, and ROI for plans; features and capabilities that are in early development phases today, will be operationalized more quickly.
SS&C Health is the only RTB partner to offer outcomes analysis that allows clients to measure actual RTB-influenced savings in addition to projected savings metrics. We launched the industry's first Real-Time Benefit pilot project in 2012, and we have been working to deliver transparency and value ever since. Today our provider footprint is among the best in the industry with more than 164K physicians using our solution each month. In addition to pricing information, therapeutic alternatives, channel options and patient-specific benefit considerations; we provide a fully adjudicated 'faux claim' at the point of prescribing so that the provider can make truly informed treatment decisions together with the patient.
Part D plans: January 2021 is not far away. Now is the time to get started on your Real-Time Benefit implementation. To learn more about RTB and how to evaluate an RTB partner, download our white paper, Real-Time Benefit: Validating Outcomes and Savings for Health Plans, Providers, and Patients.
1: CMS.gov https://www.cms.gov/newsroom/fact-sheets/medicare-advantage-and-part-d-drug-pricing-final-rule-cms-4180-f
Medication adherence , Drug Price Transparency , real-time benefit , consumer drug price transparency , CMS RTB rule