Real‑Time Prescription Price Tools May Help You Save | Simplefill
Real-time prescription price tools help patients understand exactly what their medications will cost before they reach the pharmacy. By showing coverage details, alternatives, and out-of-pocket pricing upfront, these tools can reduce surprises and help people nationwide make more affordable medication choices.
Recently, however, there’s been a push from the government to implement these tools in a mandatory and widespread manner throughout the country. What does this mean for medication costs, and can they impact what you end up paying at the pharmacy?
What does the new real-time prescription benefit mandate mean for patients?
The Centers for Medicare & Medicaid Services has made it a requirement that, by January 1, 2027, any RTPB tools used by Part D sponsors must comply with the new industry standard, namely NCPDP Real-Time Prescription Benefit Standard Version 13.
This new standard hopes to improve patient-specific, real-time cost transparency. It also strives to ensure providers have a clear idea of coverage restrictions and prior authorization requirements, allowing them to adjust their prescriptions as needed to find alternatives that patients can better afford.
- All Part D sponsors must implement this standard so that they can integrate with electronic prescribing systems and electronic health records.
- The NCPDP RTPB is meant to shorten pharmacy transaction times, reduce the need for prior authorization, and improve patient adherence by ensuring they know the exact costs of their medications.
- Patients who don’t get sticker shock when purchasing their medications are more likely to continue obtaining them. In the long run, this means lower overall healthcare costs.
How do real-time prescription benefit tools reduce medication costs?
Real-time prescription tools allow providers to instantly compare medication prices and coverage options. These tools can:
- Identify lower-cost generic alternatives
- Compare prices across local pharmacies
- Flag prior authorization requirements early
This transparency helps patients stay on prescribed treatments and reduces long-term healthcare costs.
What Is the HTI-4 Rule?
The Health Data, Technology, and Interoperability (HTI-4) Rule requires that electronic health records and other certified health IT systems implement new standards for real-time prescription benefits, electronic prescribing, and prior authorization.
The HTI-4 Rule also requires using the NCPDP RTPB to offer patient-specific medication cost data in real-time. This must occur at the point of prescribing.
To enhance efficiency and interoperability between pharmacies, payers, and providers, the HTI-4 rule also requires updated standards, including RxNorm, NCPDP SCRIPT, and Fast Healthcare Interoperability Resources.
Additionally, the HTI-4 Rule promotes the use of standardized Application Programming Interface for electronic prior authorization. This replaces the current phone-based processes that slow down the process of patients receiving their medications.
How Can Real-Time Prescription Tools Help You Afford Your Medications?
If you require medications for chronic conditions like diabetes or you need ongoing cancer treatments, you may not know what to expect, cost-wise, when you go to your pharmacy. Real-time prescription tools can assist with this by giving you a clear idea of the out-of-pocket costs based on your unique needs and circumstances.
If you know what a medication will cost, you and your provider can look for alternatives while also seeking out other solutions, like prescription assistance programs, if the price is too high.
Real-time prescription tools can immediately point out if there are generic options that offer better prices, and they can provide a side-by-side comparison of what your local pharmacies charge.
Some more advanced real-time prescription tools also help you find co-pay cards and manufacturer discount programs. Additionally, you have a chance to receive faster care without the need for multiple follow-up calls with your provider.
Get Affordable Access to Prescription Medications
Simplefill is a full-service prescription assistance company that researches, qualifies, and maintains patients’ enrollment in all sources of assistance available to them.
Apply today by calling 877-386-0206. A caring Simplefill representative will contact you within 24 hours to discuss your application and, if qualified, enroll you in the program.
Frequently Asked Questions
Get more answers to your medication cost questions.
What Is Prior Authorization?
Prior authorization is a cost-control process in which insurance companies require providers to get approval for certain medications or services. It’s meant to ensure the proposed treatment is medically necessary. If providers don’t obtain that authorization when required, insurers could refuse to cover the medications or procedures.
When Do All of These Real-Time Prescription Price Tool Updates Become Official?
As of October 1, 2025, the new requirements are official. There are some aspects of the standards that have staggered rollout timelines, however. Until December 31, 2027, the old standards will still be in place to make the transition smoother. On January 1, 2028, real-time benefit checks and all of the other standards become mandatory.
How Do Real-Time Prescription Benefit Checks Work?
This crucial part of the new standards relies on pulling data from insurance and pharmacy benefit systems. The tools can do this in seconds, giving you and your provider insight into what you can expect to pay.
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