A Real-Time Benefit Check Success Story | 2022 PBMI Annual National Conference

The need for prior authorization and shock at the high out-of-pocket expense — those are experiences that people typically have at the pharmacy, picking up their prescription, not during a medical appointment. Prior authorization and the sticker shock cause frustration, anger, and delay. And many people do not take their medication as prescribed. Some walk away and never get the prescription filled.

Real-time benefit check, which involves checking cost and coverage at the time of the prescription, is supposed to eliminate those experiences and bring them into the prescriber’s office as the prescription is being written.

But the reality check on real-time benefit check is that actual adoption has been slow and halting.

“The information presented is still not trusted,” Abhi Sindhwani said today at the 2022 PBMI Annual National Conference in Orlando, Florida. “The information sometimes is inaccurate.”

Sindhwani, senior vice president, payer/PBM market growth for Arrive Health, real-time benefits check company that used to be called RxRevu, and Lauren Hackenberg, Pharm.D., senior director of EMR engagement and provider marketing for OptumRx, led a session on real-time benefit checks at the PBMI meeting today that focused on Arrive Health and the work it has done for OptumRx. The two companies have doing business together since 2018.

Hackenberg presented a slide showing that Arrive Health’s real-time benefit check system and software resulted in the avoidance of 5,000 prior authorization approval processes per month and 14,500 drug switches. Another slide she presented showed said that as an OptumRx vendor, Arrive Health handles 2 million unique prescribing events per month and that its service extends to a million people covered by OptumRx.

Sindhwani said PBMs, not just providers, have been wary of real-time benefit check technology because they haven’t gotten the information they want from vendors and the systems they are selling. “There is unknown transaction volume. What are the member savings? How many switches are happening? Which providers are more compliant than others?” Sindhwani said. “These are all question marks. These insights are not being provided (to PBMs).

Both Hackenberg and Sindhwani talked up Arrive Health as fixing the problems that have bedeviled real-time benefit checks. For example, Sindhwani said there is an “intelligence layer” to Arrive Health’s software that can use national drug codes, the unique identifiers assigned to medications by the FDA, to locate pharmacies where a prescription is available and then identify the related insurance coverage. The Arrive Health software also curates the messaging to the providers to make sure it is clear and accurate, he said.

Real-time benefit tends to focus on a patient's out-of-pocket costs. But Hackenberg and Sindhwani said Arrive Health's software is also capable of calculating payer costs.