Drug Cost Decision Support With Real-Time Alternatives
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Solution Overview
Problem
The rising drug prescription costs in the United States are driven by a lack of cost transparency for prescribers and patients, with inconsistent information in electronic health records and limited awareness of lower-cost alternatives, leading to inefficient medication and pharmacy selection.
Innovation Solution
A drug-cost decision support platform that enrolls patients, generates drug savings reports and determination policies, and provides a graphical user interface for real-time cost and alternative drug information, allowing patients to engage in cost-effective drug selection and transfer prescriptions to preferred pharmacies.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Loss of information
If prescribers are provided with patient-specific drug costs in electronic health records, then cost transparency is improved, but information consistency and completeness deteriorate due to lack of lower cost alternative information
Solution Approach 1:
The patent introduces an intermediary system (drug cost decision support platform) that connects prescribers, patients, and payers. This platform aggregates drug cost data from multiple sources including alternative pharmacies and lower-cost alternatives, then presents comprehensive and consistent information to prescribers through the EHR interface, resolving the inconsistency problem by centralizing data collection and validation
Solution Approach 2:
The system implements feedback loops where drug cost information is continuously updated and validated across the platform. When new alternative drugs or pharmacy options become available, the system automatically updates prescriber views in real-time, ensuring information consistency through continuous verification and refresh cycles
2Measurement precision
If accurate drug and alternative costs are provided to prescribers, then decision quality is improved, but prescriber workflow complexity increases due to additional information processing requirements
Solution Approach 1:
The patent applies local quality by providing prescribers with customized, context-specific cost information directly at the point of prescribing within the EHR. Instead of overwhelming prescribers with comprehensive data sets, the system selectively displays relevant drug alternatives and cost savings specific to each patient encounter, maintaining workflow efficiency while improving decision accuracy
Solution Approach 2:
The system creates simplified copies or summaries of complex drug cost data that can be quickly reviewed by prescribers. Rather than requiring prescribers to analyze raw data from multiple pharmacies and payers, the platform generates condensed cost comparison views that preserve essential information while reducing cognitive load and workflow complexity
3Productivity
If prescribers are the sole decision-makers for medication selection, then prescribing efficiency is maintained, but patient awareness and engagement in cost-effective decisions deteriorate
Solution Approach 1:
The patent segments the medication decision-making process into distinct roles: the prescriber evaluates clinical appropriateness and patient needs, while the patient (empowered with cost information through the platform) evaluates affordability and preferences. This segmentation allows both parties to focus on their respective expertise while the platform provides the necessary cost transparency for informed patient participation
Solution Approach 2:
The drug cost decision support platform serves as an intermediary that bridges prescribers and patients during medication decisions. It provides patients with accessible cost information and alternative options, then facilitates communication between patient and prescriber, enabling collaborative decision-making that maintains prescribing efficiency while improving patient awareness and engagement
4Adaptability or versatility
If patients are directly engaged with drug cost information through digital platforms, then patient empowerment is improved, but administrative burden increases due to additional enrollment and data management requirements
Solution Approach 1:
The patent implements universality by designing the drug cost decision support platform to serve multiple functions simultaneously: it enrolls patients, collects and validates insurance and pharmacy data, generates cost information, presents alternatives, and facilitates prescription transfers. This multi-functionality consolidates what would otherwise be separate administrative systems into a single unified platform, reducing overall administrative complexity while enhancing patient engagement capabilities
Data Source
AI summary
Described herein are systems and methods for implementing a drug-cost decision-support having: an enrollment engine configured to enroll a patient and register patient-related information; a drug and savings report engine configured to generate one or more of: a drug savings report (DSR) and drug determination policies (DDP) providing cost and alternatives for one or more drugs prescribed for the patient; an outreach engine configured to respond to a medication trigger with the generated one or more of the DSR and DDP; and a graphical user interface (GUI) portal configured to display the DSR and DDP at the GUI and provide an ordering interface configured to order the one or more drugs. Thus, the platform enables patients to choose their preferred pharmacy for prescription routing, ensuring cost savings are delivered upfront and providing transparent out-of-pocket cost information before a pharmacy processes the prescription. Other examples are described.