From my perspective, one key thing that all the RTPB tools seem to miss is that the pharmacy selected by the patient (or provider for the provider-facing tools) may not be the best priced/ideal pharmacy in terms of drug costs. It might be the most convenient pharmacy for the patient to visit, but if trying to determine the best price the one nearest the patient’s house may not be the cheapest. There is an emphasis on alternative medications being returned at the selected pharmacy if the alternative medications happen to be a better price; however, it is very possible that the medication originally selected is available at a lower price at a pharmacy down the street. Patients may not understand that certain pharmacies have different relationships with payers and there can be better prices at say a CVS v. another pharmacy. The patient will likely select a pharmacy based solely on convenience or familiarity and by doing so he/she might miss out on the actual best price at another pharmacy close by.

I think it is important that these tools not only review the alternative medications at the selected pharmacy, but also review the pharmacies close by (maybe the 5 closest) to see what the prices are like for the originally selected drug.

There is a reference to “other pharmacy options” in terms of determining the best pharmacy/drug combinations. I feel like this is in reference to mail order pharmacies as the alternative pharmacy option rather than other brick and mortar retail pharmacies. If the intent of the reference to “other pharmacy options” is to not just include mail service pharmacies, then I feel like this needs to be more clearly stated.

I see there is a reference to “determines pricing for the requested pharmacy and potentially other nearby pharmacies” (link) so the intent may be to provide information for other nearby retail pharmacies, but it’s a little too up in the air and dependent on the payer’s choice whether this information will be provided in the response. I also wonder since this information is to be provided in the payer’s response, whether it will be entirely up to the payer’s discretion whether or not alternative pharmacy information will be provided, and if the payer’s relationship(s) with certain pharmacies will prevent the patient from getting the full picture of the pharmacy price options available.

Depending on the patient’s locale, there may be many potential pharmacies in the area. It may be challenging to display a large number of potential pharmacies in a consumer-facing app due to size restrictions. In addition, pharmacy stakeholders have raised concerns in many NCPDP conversations about how alternative pharmacies will be displayed and in what order. It is critical that pharmacy stakeholders be included in the discussions for this guide to ensure that these concerns are adequately addressed.

Pricing should be provided for nearby pharmacies, not just pricing for alternative drugs at the selected pharmacy. Possible for the patient's selected pharmacy to not be the best priced pharmacy, so pricing for the selected drug at other nearby pharmacies should be displayed.

Existing Wording:

Request: Information to identify the patient and their insurance\. Core prescription info and preferred pharmacy\.

Response: Cost and coverage for the requested medication and alternatives\. At the preferred pharmacy and options\.