Sen. Ron Wyden, D-Ore., wants to place a pop-up on providers' EHRs with prescription drug price information and alternative options, including different medications and pharmacies for pick-up. The intervention at the point of prescribing is meant to allow for comparison shopping.
The Senate Finance committee ranking member pitched his idea Wednesday at the Health Datapalooza conference. "What we are going to propose is making it possible and promoting that when a physician logs into his or her health IT system to prescribe a medicine, a screen will pop up — Heaven forbid we actually use all the screens to help the consumer — a screen would pop up to tell the doctor and patient what's available, what the prices are and where it is," he said.
Wyden's loose three-pronged proposal also includes requiring public and private payers to give enrollees cost information via telephone or online tools, along with general information on out-of-network cost-sharing provisions of the patient's coverage. Concrete legislation will be released "at a later date," according to his office.
While the plan lacks specifics and would face a long road ahead with Republicans in control of the Senate and White House, promoting price transparency in healthcare has won bipartisan support.
Many lament that consumers nearly never know the price of a healthcare service or medication and are increasing hit with high deductibles and greater cost-sharing.
In August, CMS required hospitals post their chargemasters online for patient viewing, ostensibly to facilitate comparison shopping between facilities for comparable services. But there's no way to enforce that rule. Critics call it misleading either way as the sticker price hospitals publish is almost never the price consumers pay.
Patients are often left without a solution and tangled in a net of weighty bills. About four in every 10 Americans report receiving a surprisingly high unexpected medical bill in the past year, with another 38% "very worried" about being able to afford one.
Wyden's plan aims to give consumers price estimates (including service price, insurance coverage and out-of-pocket payments for in-network medical services), requiring public and private insurers to provide cost information to beneficiaries through online search tools or via telephone and adding out-of-pocket cost information for prescription drugs in a provider's EHR at the point of prescribing.
"Under my proposal, doctors can tell their patients about all the options so they can, together, choose the best deal for them," Wyden said.
The measures won't, however, make a dent in the sweeping costs associated with emergency care such as ambulance transport or pricey emergency room visits. A 2017 Health Affairs study found that 20% of all hospital inpatient admissions originating in the ER resulted in surprise medical bills.
Wyden's preliminary outline also lacks many important specifics, such as potential ramifications on EHR usability or increased administrative burden on providers.