Rising drug costs have plagued the nation for decades but addressing the issue through federal and state policy has proven difficult. To combat the problem, Congress passed the 21st Century Cures Act to tackle one side of the equation – health cost transparency. In response, the Centers for Medicare and Medicaid Services (CMS) developed rules to comply with the transparency in pricing directive which directed Medicare Part D sponsors to implement real-time benefit tools (RTBTs) for prescribers in 2022 and for enrollees by January 1, 2023.
Since the rule went into effect, enrollees have continued to suffer from too high drug costs. So, what happened? RTBTs held great promise because they allowed prescribers to access drug pricing and benefit information at the point of care, theoretically enabling them to choose the lowest-cost medication before the patient leaves the office. This should have lowered direct out-of-pocket costs for patients and indirectly limited drug benefit expenses for plans.
While the rollout of the RTBT rule spawned significant buzz, adoption remained stubbornly thin, despite the mandates. Beyond the slow and problematic adoption, there are other significant roadblocks to navigate before RTBTs will be a valuable player in the fight against uncontrolled drug cost spending. The unfortunate reality is that the current RTBT rule has no teeth.
In a recent analysis of the RTBT market and rollout, RazorMetrics identifies three main areas of concern with prescriber RTBTs that must be addressed before the tool can fulfill its promise.
- The Point-of-Care Problem
Policymakers and technology developers focused heavily on the point of care as the ideal intervention point. However, this assumption does not align with the reality of clinical workflows. For example, clinics have a rigid workflow to ensure patients are seen in a timely manner. Any tool that disrupts that process will be rejected.
Often, physicians have access to multiple RTBTs, each offering different data, which makes it difficult to navigate conflicting information. Since, physicians already operate under tight schedules, a tool that adds time to appointments without clear benefits will be ignored.
- Data Accuracy Questions
RTBTs are dependent on up-to-date and accurate data that is highly accessible. Many RTBTs suffer from integration challenges because the tool must aggregate data from thousands of plan sponsors, PBMs, and EHR developers, making real-time accuracy difficult to achieve. When physicians experience inaccuracies in the RTBT, then trust is lost and they are unlikely to use it again.
- Lack of Quantifiable Benefit
RTBTs have struggled with a viable business model because of disagreements over who should pay for the tool. The savings derived from the tool are not provable. There is no clear way to measure how RTBT use translates into cost reductions. Most unusual, RTBT compliance is not tied to savings. Plans must provide the tool, but they are not required to demonstrate that it generates actual savings. Further, RTBTs do not capture refill savings. Chronic condition medications remain unchanged over time, and RTBTs do not track new lower-cost alternatives after the initial prescription.
The RazorMetrics Solution
RazorMetrics achieves the same goal as RTBTs—reducing drug costs—but in a way that seamlessly integrates into existing workflows and delivers quantifiable savings.
A Smarter Approach to Cost Savings
- Physician engagement without disruption: RazorMetrics provides lower-cost alternatives directly to prescribers at the most effective intervention points—such as during the refill process—without requiring additional steps or clicks in an EHR.
- Data accuracy and reliability: Unlike RTBTs, which struggle with data access due to competitive barriers, RazorMetrics leverages plan sponsors’ data, ensuring accuracy and actionable insights.
- Built-in adoption: RazorMetrics works directly with plan sponsors, meaning that physicians prescribing to their covered members are automatically part of the solution.
The End-to-End Advantage
Unlike RTBTs, which primarily function at the point of care, RazorMetrics captures savings throughout the medication lifecycle, including refills. By continuously identifying lower-cost alternatives and deprescribing opportunities, RazorMetrics ensures ongoing cost containment that RTBTs simply cannot achieve.
RazorMetrics created a more complete, end-to-end solution that is the easiest and fastest way to lower drug costs. If and/or when RTBTs resolve the data issues, they will still be limited by the point-of-care model and only catch a small amount of excess spend. Health plans, PBMs, and employers clearly see the difference with RazorMetrics’ unique solution, catching excess spend continuously.
Combining RazorMetrics with the mandated RTBT creates an opportunity to control drug costs while complying with federal rules. The RTBT can try to capture savings in the clinic and RazorMetrics catches everything else.
RTBTs were built with good intentions, but they lack the necessary framework to drive real cost savings. RazorMetrics presents a superior, data-driven approach that ensures sustained reductions in prescription drug spending—without disrupting provider workflows, burdening members, or relying on incomplete data. By working in tandem with RTBTs where applicable, RazorMetrics delivers a comprehensive, end-to-end solution that maximizes savings for health plans, PBMs, and self-funded employers.
About RazorMetrics
RazorMetrics creates cutting-edge pharmacy cost containment solutions to quickly and easily reduce drug spend. Its proprietary technology automatically initiates cost-saving opportunities through medication switching, deprescription, and more—all while adapting to fit clients’ plans, preferences, and formularies. RazorMetrics conveniently integrates into prescriber workflows, improving healthcare decisions while seamlessly reducing medication costs for members and plan sponsors. Based in Austin, TX, RazorMetrics supports self-funded employers, health plans, PBMs, and organizations to bring clarity, efficiency, and more value to their pharmacy benefits.
