Surescripts Deal Connects EMR Vendors And PBMs To Improve Price Transparency

Posted on November 22, 2017 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

I’m no expert on the pharmacy business, but from where I sit as a consumer it’s always looked to me as though pharmaceutical pricing is something of a shell game. It makes predicting what your airline ticket will cost seem like child’s play.

Yes, in theory, the airlines engage in demand-oriented pricing, while pharma pricing is based on negotiated prices spread among multiple contracted parties, but in either case end-users such as myself have very little visibility into where these numbers are coming from.  And in my opinion, at least, that’s not good for anyone involved. You can say “blah blah blah skin in the game” all you want, but co-pays are a poor proxy for making informed decisions as a patient as to what benefits you’ll accrue and problems you face when buying a drug.

Apparently, Surescripts hopes to change the rules to some degree. It just announced that it has come together with two other interest groups within the pharmacy supply chain to offer patient-specific benefit and price information to providers at the point of care.

Its partners in the venture include a group of EMR companies, including Cerner, Epic, Practice Fusion and Aprima Medical Software, which it says represent 53% of the U.S. physician base. It’s also working with two pharmacy benefit managers (CVS Health and Express Scripts) which embrace almost two-thirds of US patients.

The new Surescripts effort actually has two parts, a Real-Time Prescription Benefit tool and an expanded version of its Prior Authorization solution.  Used together, and integrated with an EHR, these tools will clarify whether the patient’s health insurance will cover the drug suggested by the provider and offer therapeutic alternatives that might come at a lower price.

If you ask me, this is clever but fails to put pressure on the right parties. You don’t have to be a pharmaceutical industry expert to know that middlemen like PBMs and pharmacies use a number of less-than-visible stratagems jack up drug prices. Patients are forced to just cope with whatever deal these parties strike among themselves.

If you really want to build a network which helps consumers keep prices down, go for some real disclosure. Create a network which gathers and shares price information every time the drug changes hands, up to and including when the patient pays for that drug. This could have a massive effect on drug pricing overall.

Hey, look at what Amazon did just by making costs of shipping low and relatively transparent to end-users. They sucked a lot of the transaction costs out of the process of shipping products, then gave consumers tools allowing them to watch that benefit in action.

Give consumers even one-tenth of that visibility into their pharmacy supply chain, and prices would fall like a hot rock. Gee, I wonder why nobody’s ever tried that. Could it be that pharmaceutical manufacturers don’t want us to know the real costs of making and shipping their product?