Surescripts Real-Time Prescription Benefit for Pharmacy Tool: Big Advance or a Non-starter?

In early June, Surescripts announced the launch of its new Real-Time Prescription Benefit for Pharmacy Tool, which allows “pharmacists to access information on out-of-pocket prescription costs and therapeutic alternatives at the point of dispensing.”[1]   Surescripts promotes that the tool will enable pharmacists to “collaborate with patients and prescribers on choosing an alternative medication that is both clinically appropriate and affordable.”  The tool accesses the patients’ prescription benefit information to provide days’ supply constraints and potentially less expensive formulary alternatives.

The premise behind this service is the pharmacist is willing to provide therapeutic substitution recommendations to the prescriber and patient at the point of dispensing.  If this tool gains momentum, expect drugs with a prior authorization to be placed at a significant disadvantage.  In many cases, the pharmacy patient will have just come from the provider’s office with a prescription, where the expectation is the provider should have had this discussion with the patient prior to writing the prescription.  We expect pharmacists to continue to submit prescriptions to the payers for adjudication and only suggest therapeutic substitutions if a claim is rejected and/or the patient voices a concern, which is standard operating procedure today.

The new Surescripts tool provides pharmacists with the opportunity to evaluate options before contacting the prescriber.  The cost to the pharmacist is unknown at this time.  More than likely, the pharmacist will contact the prescriber and let the prescriber evaluate and prescribe a different product if warranted. With continued reductions in pharmacy reimbursement, we do not expect widespread adoption of this new tool in pharmacy practice.  This new tool repackages the Real Time Benefits Check (RTBC) available to prescribers and will likely be a non-starter in pharmacy practice.  As is currently seen in the prescriber space, the validity and usability of this tool will depend on payers’ ability to provide updated formulary and pricing information to Surescripts in a timely manner.  If prescriber uptake of these RTBCs occurs, the use in pharmacies would not be needed.

[1]!content/surescripts-empowers-pharmacies-with-benefits-based-prescription-price-transparency-tool, Accessed June 15, 2020.


Posted June 16, 2020

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