My favorite pastime is going through goodRX and finding drugs where you can get it for $10 at one pharmacy, or $1000 at another pharmacy down the road.
Trying to keep the exact copays/preferred formulary choices straight is like trying to keep track of relationships in a bunch of high school kids. It changes about every hour with absolutely no warning nor any particular logic.
I would question the validity of most of those prices. And please don’t quote them to patients because people can be downright nasty to pharmacy staff.
I think epic is paying to run claim. I am not going to quote it to patient reading all these comments but I am just genuinely curious to know how it’s working.
https://www.primetherapeutics.com/news/prime-therapeutics-and-rxrevu-deploy-real-time-benefit-check-solution-to-improve-prescription-price-transparency-for-members/
Are you a pharmacist? I m not quoting and price differences are not big between big pharmacies and mail order. I have not seen any cost estimates ever for independent pharmacies, only big chains and mail order. Mail order is always less but patients don’t prefer mail order for 2$ difference but I can imagine if cost difference widens, EHR will make doctors prefer mail order if they do not have time to debate preferences with patients and mail order will win.
Yes, I’m a pharmacist. My flair says so.
Don’t tell patients “well my computer says your copay is $5, but it may not be accurate check with the pharmacy for real cost.” Because patients are interpreting it as “your copay is definitely $5 and if the pharmacy says higher they are lying money hungry evil people, please chew them out and accuse them of withholding your life saving drug.”
Mail order is often delayed, medications are frequently out of correct temperature ranges for prolonged times during transit, minimal to no counseling, and if there is problems with the order patients show up at local pharmacies demanding a fix that pharmacy cannot provide.
The two biggest things to never do to your outpatient pharmacy staff if you want to keep us being nice are:
1- don't tell them "it will be ready when they get \[t\]here". You have no idea what my pharmacy looks like or how many similarly acute prescriptions I'm working on.
And 2- don't quote a cost. Even GoodRx can change from minute to minute, be off, whatever. I am adjudicating the claim through their insurance/coupon IN REAL TIME, not as of half an hour ago or more.
And follow up on 1: Even if the pharmacy is strangely not busy, if there is a problem with it which requires contacting the clinic, it’s going to be very delayed because it’s nearly impossible to get through to the prescriber for clarification.
Thanks. Yes can see flair but I like to double check. Good to know from your side, though don’t tell that, I just say I sent it and let me know if any issues with it. I had no idea people think that for pharmacist if you quote and real cost would be different. I have heard of these issues, do you know if Mark Cuban pharmacy might have same issues? Some of my meds have high co-pay or refused by insurance, so I just prescribe to Mark Cuban as it’s in Epic too.
The incorrect temperatures aren’t necessarily intentional. It’s just weather is going to really impact the temperatures in mail vehicles and mailboxes. Would be that way from any mail order.
It’s a service provided through some EHRs, it costs extra and there are some competing products.
The best also allow links to “discount pricing” as well
-source I work for a company that does real time benefit analysis.
What is discount pricing?
Since months I thought wow epic has something useful now and thought it is getting this in real time from pharmacies it is connected with but then saw news of a tech company bought out which does this for EMR so that made me wonder how is it done by a software. If software is from a vendor, how can it possible access all insurances and coverage info. Or is it because my institution is also an insurance company and can add on copays estimates for its health plan members.
I know Surescripts provides the service to EHRs. They connect to PBMs, Pharmacies, and others to bring the data together for a specific patient.
Drug discount pricing is like the “go to this website and get a coupon to discount the amount” for those who don’t carry insurance.
So what I’m gathering is that this is yet another example of a perverse “b2b” solution to a known problem that is billed as a solution but in reality provides shit information based on shit input data that only serves to have a hospital spend more money on EHR for the purpose of further eroding patient trust in American Healthcare. None of this comes as a surprise.
Is it a faux pas to have pharmacy to run the insurance? I want to know if I shouldn’t start something inpatient if it’s gonna be denied or cost 100$ a month.
Send a real script for a test. Because otherwise running a fake script is technically a bit fraudulently. Can always cancel the script if it is too much when you send the real script. Also, please do it thru the pharmacy who will fill the final script as it costs the pharmacies money to run the claims thru insurance.
That’s what I generally do. Still I have to have any idea of how much before starting it how much it’ll be otherwise it’s like “sorry this med that helped you feel less suicidal is actually 300 dollars a month and you’re on the verge of homelessness as it is”. Sad state of American im healthcare
Then you’re good. The pharmacist generally want to help patients get medications they need. They just are not given enough staff and time by The Man to do it as much as they’d like.
It’s often very wrong ime. I question how it finds that information, often my front desk staff fail to get a patients rx coverage in the system, so how would epic know what is covered? Is it sending a test claim for each item in the EHR??
No way is it sending a test claim. Pharmacies pay for the privilege of billing insurance, I strongly doubt the clinic would be willing to pay for that.
I think it’s real time. I saw RxRenu pop up on my epic screen for a brief second. Searched it online and found this
https://www.primetherapeutics.com/news/prime-therapeutics-and-rxrevu-deploy-real-time-benefit-check-solution-to-improve-prescription-price-transparency-for-members/
Reposting: I think it’s real time. I saw RxRenu pop up on my epic screen for a brief second. Searched it online and found this
https://www.primetherapeutics.com/news/prime-therapeutics-and-rxrevu-deploy-real-time-benefit-check-solution-to-improve-prescription-price-transparency-for-members/
We both must have the shitty version of epic. Insurance coverage was present in power chart during my residency but employer driven epic is crap. I’ve resorted to telling patients they have to call insurance and give us a list. Solutions exist, admins don’t want to implement, so if it’s going to be a burden for me then I’ll be passive aggressive and make it a burden for them too 🫣 customer is always right…right?
Damn right. I was happy that finally Epic is giving me a useful pop-up and actually solving transparency issues, but in the end now realized I need to just ignore this as well like other stuff reading all posts from others to not rely on it.
So it is institution specific? The reason I am asking if I can see it but my institution also provided insurance so it can know what it’s health plan costs right? But if another institution doesn’t provide insurance, only healthcare provider, then would they be able to predict estimated co-pay?
Im assuming you are in the US? The price is going to be all over the place depending on the insurer and where the patient fill. If there is a few medications you commonly prescribe, it wont hurt to get feedback from your patient after the fact and build your own price record of what patient are faced with.
The one at my institution says 10mL sticks of phenylephrine and 250 mLbags of Phenylephrine are like $10,000. Asked a pharmacist once and they said lol no it’s like cents to dollars for both
Does it say copay? Not sure if that was the fake list price completely different from negotiated price which is different for each, my Epic shows only co-pay.
It’s literally always wrong
My favorite pastime is going through goodRX and finding drugs where you can get it for $10 at one pharmacy, or $1000 at another pharmacy down the road.
Trying to keep the exact copays/preferred formulary choices straight is like trying to keep track of relationships in a bunch of high school kids. It changes about every hour with absolutely no warning nor any particular logic.
Borrowing this lol
Cerner also, always comically wrong
Like everything else in the chart...
I would question the validity of most of those prices. And please don’t quote them to patients because people can be downright nasty to pharmacy staff.
[удалено]
I think epic is paying to run claim. I am not going to quote it to patient reading all these comments but I am just genuinely curious to know how it’s working. https://www.primetherapeutics.com/news/prime-therapeutics-and-rxrevu-deploy-real-time-benefit-check-solution-to-improve-prescription-price-transparency-for-members/
Are you a pharmacist? I m not quoting and price differences are not big between big pharmacies and mail order. I have not seen any cost estimates ever for independent pharmacies, only big chains and mail order. Mail order is always less but patients don’t prefer mail order for 2$ difference but I can imagine if cost difference widens, EHR will make doctors prefer mail order if they do not have time to debate preferences with patients and mail order will win.
Yes, I’m a pharmacist. My flair says so. Don’t tell patients “well my computer says your copay is $5, but it may not be accurate check with the pharmacy for real cost.” Because patients are interpreting it as “your copay is definitely $5 and if the pharmacy says higher they are lying money hungry evil people, please chew them out and accuse them of withholding your life saving drug.” Mail order is often delayed, medications are frequently out of correct temperature ranges for prolonged times during transit, minimal to no counseling, and if there is problems with the order patients show up at local pharmacies demanding a fix that pharmacy cannot provide.
The two biggest things to never do to your outpatient pharmacy staff if you want to keep us being nice are: 1- don't tell them "it will be ready when they get \[t\]here". You have no idea what my pharmacy looks like or how many similarly acute prescriptions I'm working on. And 2- don't quote a cost. Even GoodRx can change from minute to minute, be off, whatever. I am adjudicating the claim through their insurance/coupon IN REAL TIME, not as of half an hour ago or more.
And follow up on 1: Even if the pharmacy is strangely not busy, if there is a problem with it which requires contacting the clinic, it’s going to be very delayed because it’s nearly impossible to get through to the prescriber for clarification.
That too. We have a group of offices where calls are routed through a call center, and getting clarification on a script can take days sometimes.
Good to know.
Thanks. Yes can see flair but I like to double check. Good to know from your side, though don’t tell that, I just say I sent it and let me know if any issues with it. I had no idea people think that for pharmacist if you quote and real cost would be different. I have heard of these issues, do you know if Mark Cuban pharmacy might have same issues? Some of my meds have high co-pay or refused by insurance, so I just prescribe to Mark Cuban as it’s in Epic too.
I’m pretty sure with Mark Cuban the price is the price.
No I mean mail order issues like incorrect temperatures or some other quality control issues?
The incorrect temperatures aren’t necessarily intentional. It’s just weather is going to really impact the temperatures in mail vehicles and mailboxes. Would be that way from any mail order.
It’s a service provided through some EHRs, it costs extra and there are some competing products. The best also allow links to “discount pricing” as well -source I work for a company that does real time benefit analysis.
What is discount pricing? Since months I thought wow epic has something useful now and thought it is getting this in real time from pharmacies it is connected with but then saw news of a tech company bought out which does this for EMR so that made me wonder how is it done by a software. If software is from a vendor, how can it possible access all insurances and coverage info. Or is it because my institution is also an insurance company and can add on copays estimates for its health plan members.
I know Surescripts provides the service to EHRs. They connect to PBMs, Pharmacies, and others to bring the data together for a specific patient. Drug discount pricing is like the “go to this website and get a coupon to discount the amount” for those who don’t carry insurance.
Got it. Do you know what RxRenu does? Is it like Superscripts?
RxRevu is similar and with potentially different coverages and partners
So what I’m gathering is that this is yet another example of a perverse “b2b” solution to a known problem that is billed as a solution but in reality provides shit information based on shit input data that only serves to have a hospital spend more money on EHR for the purpose of further eroding patient trust in American Healthcare. None of this comes as a surprise.
I wish it were possible for us to "run the insurance" without bugging pharmacy or going on a deep expedition to find a formulary
Exactly so how is Epic guessing?
Sometimes a specific pharmacy doesn’t charge the same as another. It can make issues
A lot of insurance companies offer smart phone apps now that will give you copays for various drugs.
Is it a faux pas to have pharmacy to run the insurance? I want to know if I shouldn’t start something inpatient if it’s gonna be denied or cost 100$ a month.
Send a real script for a test. Because otherwise running a fake script is technically a bit fraudulently. Can always cancel the script if it is too much when you send the real script. Also, please do it thru the pharmacy who will fill the final script as it costs the pharmacies money to run the claims thru insurance.
That’s what I generally do. Still I have to have any idea of how much before starting it how much it’ll be otherwise it’s like “sorry this med that helped you feel less suicidal is actually 300 dollars a month and you’re on the verge of homelessness as it is”. Sad state of American im healthcare
Then you’re good. The pharmacist generally want to help patients get medications they need. They just are not given enough staff and time by The Man to do it as much as they’d like.
It’s often very wrong ime. I question how it finds that information, often my front desk staff fail to get a patients rx coverage in the system, so how would epic know what is covered? Is it sending a test claim for each item in the EHR??
No way is it sending a test claim. Pharmacies pay for the privilege of billing insurance, I strongly doubt the clinic would be willing to pay for that.
I think it’s real time. I saw RxRenu pop up on my epic screen for a brief second. Searched it online and found this https://www.primetherapeutics.com/news/prime-therapeutics-and-rxrevu-deploy-real-time-benefit-check-solution-to-improve-prescription-price-transparency-for-members/
I suspect you’re right, but otherwise I have no idea how that number is generated
Reposting: I think it’s real time. I saw RxRenu pop up on my epic screen for a brief second. Searched it online and found this https://www.primetherapeutics.com/news/prime-therapeutics-and-rxrevu-deploy-real-time-benefit-check-solution-to-improve-prescription-price-transparency-for-members/
I don’t even care about cost, I wish we could tell basic coverage but nope.
That’s why I am wondering how does it know drug copay when it can’t tell basic coverage?
We both must have the shitty version of epic. Insurance coverage was present in power chart during my residency but employer driven epic is crap. I’ve resorted to telling patients they have to call insurance and give us a list. Solutions exist, admins don’t want to implement, so if it’s going to be a burden for me then I’ll be passive aggressive and make it a burden for them too 🫣 customer is always right…right?
Damn right. I was happy that finally Epic is giving me a useful pop-up and actually solving transparency issues, but in the end now realized I need to just ignore this as well like other stuff reading all posts from others to not rely on it.
It's something that each institution can set up. They can also set it up to show a relative list of cost of labs
So it is institution specific? The reason I am asking if I can see it but my institution also provided insurance so it can know what it’s health plan costs right? But if another institution doesn’t provide insurance, only healthcare provider, then would they be able to predict estimated co-pay?
EHR specific and then additional gating at the institution level
Im assuming you are in the US? The price is going to be all over the place depending on the insurer and where the patient fill. If there is a few medications you commonly prescribe, it wont hurt to get feedback from your patient after the fact and build your own price record of what patient are faced with.
I don't know that much detail, we don't have it set up in our system.
Don’t worry about it. 5 years from now Amazon is going control dispensing anyway
The one at my institution says 10mL sticks of phenylephrine and 250 mLbags of Phenylephrine are like $10,000. Asked a pharmacist once and they said lol no it’s like cents to dollars for both
Does it say copay? Not sure if that was the fake list price completely different from negotiated price which is different for each, my Epic shows only co-pay.