LET'S BE TRANSPARENT

We've been offering price transparency in the complex prescription drug market for more than a decade. It's what we do. That’s one reason we haven’t been surprised to see new federal regulations aimed at giving consumers access to real-time healthcare costs—including drug pricing. As these policies begin to take effect, our question is:

Are you ready?

OUR PROVEN SOLUTION CAN HELP MAKE SURE YOU ARE.

THE BASICS: NEW CMS REQUIREMENTS

The Centers for Medicare and Medicaid Services (CMS) Transparency in Coverage rule (CMS-9915-F) requires private insurers to post real-time cost-sharing information, out-of-pocket coverage rates and in-network drug pricing. In short, transparency is no longer voluntary. Penalties for non-compliance could be as high as $300 per plan participant per day.

With regulations beginning to take effect, here are some key dates to keep in mind:

 

January
2022

Historical drug prices, in-network rates, out-of-network historic payments and billed charges must be made public.

 

January
2023

Standard costs for an initial list of 500 medical items and services must be available in an internet-based self-service tool.

 

January
2024

Costs for all covered services and prescription drugs must be available in an internet-based self-service tool.

 

WHAT ABOUT MEDICARE ADVANTAGE?


Effective
January 2023, another CMS regulation (CMS-4190-F2) will require Part D plans to offer their beneficieries access to a Real-Time Benefit Tool (RTBT). This comparison tool must allow enrollees to review options under their current prescription drug plan and give them the ability to choose lower-cost alternative therapies. Fortunately, our solution already meets these RTBT requirements.

 

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TRANSPARENCY BLOG SERIES

Check out our ongoing blog series on price transparency to learn more about what these new regulations will mean to your organization.

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WHY TRANSPARENCY MATTERS

Aside from avoiding costly penalties, you may be asking: Why should I embrace price transparency? The answer really comes down to trust. By educating your members on all their medication options, you solidify your role as trusted partner. And with trust comes three key benefits:

 

STRONGER ENGAGEMENT


Members become more active participants in their heathcare journey and are empowered to make better decisions.

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IMPROVED ADHERENCE


Lower-cost medications or treatments can lead to better medication adherence and improved health outcomes.

Lower-cost medications can lead to improved medication adherence.

MEMBER SATISFACTION


Healthier, happier members often translate to higher NPS scores and more positive survey results.

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LOOKING BEYOND COMPLIANCE

After more than 10 years helping our clients and members make sense of prescription drug pricing, we’ve learned that simply complying with regulations isn’t enough. Yes, our technology creates the drug price transparency CMS is soon requiring. But we take that data a step further and share it with members in a way that empowers them to take action and take control of their out-of-pocket drug costs. Here’s how we do it:

 

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Offer a proven platform for member engagement.

 

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Partner with health plans and employers to drive ROI.

 

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Enhance the experience for Medicare Advantage members.

 

WANT TO LEARN MORE ABOUT OUR SOLUTION?

CONTACT US TODAY.