January 25, 2022

It takes a system to beat the system.

How Gifthealth adds certainty to patient therapy.

Einstein believed the universe doesn’t play dice. There are laws governing how the world works with absolute certainty. We may not have discovered all of them, but they exist, nonetheless. Of course, Einstein never had to fill a prescription in 2022.  

Granted, the system for getting prescription drugs is built by humans. It’s reasonable to assume it’s going to be flawed. But the amount of uncertainty patients face every time they need to fill a prescription is a truly–ahem–dicey situation. 

How much am I going to pay for this prescription? 

For most goods, cost is a fairly well-known variable in the decision to buy. Not the case with prescriptions. A medication can vary as much as $100 from pharmacy to pharmacy. 

It’s not surprising then that a recent study found Americans overpay for prescriptions 23% of the time.  

And point-of-purchase fluctuations aren’t the only issue. Prices set for drugs up the supply chain can be downright whacky, leading one research organization to pen an article under the title “All aboard the summer drug pricing roller coaster” just last August. Prices for medications rose, fell and rose again–in some cases by over 60% (check it out here

The price for any given medication is all too often a surprise–either a pleasant one or a negative one–that’s only revealed at checkout. 

When can I get my prescription?

In many cases, patients go to their pharmacy, wait the average 45 minutes, and head home with their medications. In other cases, their insurance company requires a prior authorization (PA). 

PAs are required for some medications before an insurance company will cover them. The average delay in therapy is 1-3 days but can be longer–a week or more. Which means, not only is the cost of a drug an unknown, but so is the availability. 

Prescribers have been outspoken about the repercussions of these delays. Nearly 80% believe that patients abandon prescriptions due to difficult PAs. Prescription abandonment is a huge problem in the U.S. Approximately 110 million prescriptions are abandoned annually. Of that number, 55 million are never filled by an alternative therapy. 

But not only is abandonment an issue, so is something called non-adherence. Basically, that’s when patients receive their medication but don’t take them as prescribed. It’s estimated that 13 million of us skip doses due to cost alone. 

That’s millions of Americans not getting the medication they need due to high cost or issues with access.

It takes a system to beat the system.

Uncertainty about cost and access is business as usual. Gifthealth is in the business of bringing as much certainty to each prescription transaction as possible. Not by controlling the market, but by reacting to it with a systematic approach that combines proprietary tech and human expertise. 

An AI-driven savings platform crunches patient benefits information, historical medication pricing and pharmacy data to zero in on the lowest possible price for every patient. It works by

  • Maximizing patient insurance benefits. 
  • Finding the lowest available cost. 
  • Auto-applying savings through electronically stored manufacturer coupons and rebates.

An automated prior authorization system works to reduce approval times and increase approval rates, exceeding industry averages regardless of insurance restrictions to get medications in the hands of patients when they need them–not next week.  

One point of contact for everyone simplifies even the most complex path to fulfillment and purchase for patients, prescribers and insurance companies by eliminating missed calls (phone tag) and adding a level of accountability and efficiency designed to work through common delays to therapy. 

Industry-wide relationships at each point in the prescription journey create advantages for communicating trends, negotiating prices, solving ad hoc issues, developing operational efficiencies and increasing scale. 

  • Manufacturer relationships provide greater access to all available coupons and rebates as well as opportunities for negotiated volume discounting. 
  • Independent pharmacist partnerships grow our national network, providing better pricing and service to patients anywhere in the country.
  • Prescriber affiliations combine the efforts of care providers and pharmacists to ensure the timely delivery of therapy to every patient. 
  • Insurance expertise provides the knowledge-base necessary to anticipate barriers and develop efficient workarounds. 

A continuously optimized platform based on data-driven insights and new relationships eliminate or reduce the cost/access barriers to patient care at each step of the prescription journey, from the manufacturer through the prescriber and ultimately into the patient’s hands.

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