What Your Doctor Doesn't Know Can Cost You

Healthcare provider holding prescription pad and pen

“I keep telling them not to prescribe that. A lot of insurance companies don’t even cover it!”

That’s what a physicians’ office administrator told a member of our Pharmacy Support team last week when we called to get approval for a prescription change (from Celecoxib to a cheaper NSAID on our member’s plan, in his case a switch that’s worth $665.15 annually).

Unless you’re an MD yourself, you probably never question what your doctor says. Second opinions often make sense, but few of us ever get one unless it’s a significant diagnosis.

Often when Rx Savings Solutions suggests a cost-saving, therapeutically equivalent alternative, a member will say “Well, I trust my doctor.” Can anyone question someone with 12 years or more of higher education and all that clinical experience?

Well, on this topic anyway, the administrator knew more than the doctor she worked for, and patients can too. The fact is few doctors have any idea what any prescription will cost an individual patient. How could they with the way the system works?

It’s not that patients aren’t inquiring. A 2020 survey on prescription price transparency and patient experience found that 56 percent of patients say they discuss price with their providers, and often are the ones that start the conversation.

Until healthcare providers have instant insight into costs and coverages for their insured patients, they will continue to prescribe medications with little regard for out-of-pocket costs (let alone the payer’s share). Remember this story?

The promise of “Real-time Benefit Check” (RTBC) functionality in a truly interoperable Electronic Medical Record (EMR) may ultimately deliver this much-needed transparency at the point of prescription.

However, the solutions out there now leave a lot to be desired. For one, they lack depth in terms of clinical suggestions, often only those a PBM wants to put forth. Not to mention the solutions we’ve seen do not take payer cost into consideration. And, apparently, only one in five doctors has ever used one.

RTBC will be better and more widespread someday. In the meantime, consumers are still mostly on their own. Without a resource like Rx Savings Solutions, most will continue to pay more for medication than they should.

Doctors may not have the time or capability to research costs and clinical alternatives, but our nearly 8 million members do—in their personal portal or in our app, which they can quickly reference in a provider’s office.

Yes, you should trust your doctor. But when it comes to medication costs, Rx Savings Solutions is here to help both of you.