Real-Time Benefit Check and ActiveRADAR

Real-time benefit Check (RTBC) is an electronic prescription decision support tool that physicians use when writing prescriptions. This tool enables providers to choose the most cost-effective, therapeutically appropriate medication for their patient.

Starting this year, every Medicare Part D plan sponsor is required to have a RTBC in place.  According to CMS, “RTBC tools have the capability to inform prescribers when lower-cost alternative therapies are available under the beneficiary’s prescription drug benefit, which can improve medication adherence, lower prescription drug costs, and minimize beneficiary out-of-pocket costs.”

These systems have been shown to save patients and healthcare plans significant amounts. Early CMS data reveal that, on 45% of prescriptions, RTBC saves an average of $130 per patient. As an added benefit, CMS also anticipates that RTBC will help improve medication adherence since on average, 30% of prescriptions do not get filled by patients, partly due to cost.

ActiveRADAR can take RTBC a step further.  ActiveRADAR’s Therapeutic Alternative Service (AR-TAS) is not only formulary specific, but indication- and dose-specific.  In addition, plan costs (not just member costs) are displayed to prescribers so they are fully aware of the health care system impact of prescribing decisions.  All done in a turn-key manner for the health plan and PBM through the ActiveRADAR technology platform.

When RTBC is combined with ActiveRADAR’s Value-based Reimbursement program, great things happen including:

  • Increased member incentive to switch to clinically appropriate, lower cost alternatives
  • Coordinated, targeted member and physician communications
  • Coordinated Point of Care and Point of Sale messaging
  • Linked to broad, employer-based member education campaigns
  • Robust, NPI-level reporting & analytics – – EMR encounters linked to claims data

As healthcare costs continue to rise, as an industry, we need to make sure that we are doing all we can to help patients and plans receive quality care at affordable prices. ActiveRADAR has a dynamic, market-based, value-based reimbursement program that is constantly reviewed and updated to deliver the lowest cost prescription options, driving immediate savings for plan sponsors and their members. RTBC is an important first step; with the integration of RTBC and therapeutic alternative benefit designs, we have a powerful new strategy for pharmacy benefit management.

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