Quick Reference — To check a prescription price while prescribing a medication

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athenaOne for Hospitals & Health Systems

 

When you create a medication order, you may see the estimated price that the patient can expect to pay at the pharmacy. This price is based on the patient's insurance information and preferred pharmacy. (This feature is sometimes called real-time benefit check or RTBC.)

 

The estimated price displayed in athenaOne may differ from the actual price that the patient pays at the pharmacy, based on additional factors determined by the patient's insurance. The prescription price is returned from the pharmacy benefit manager (PBM) and the preferred pharmacy selected on the order.

Note: athenaOne displays prices from PBMs, including Humana, UnitedHealthGroup/OptumRx, Abarca, MedImpact, Navitus, CVS Caremark, DST Pharmacy Solutions, Express Scripts, Gemini Health, and Prime Therapeutics. athenahealth continues to add more vendors to increase price availability and market coverage.

 

You may also see the cash price (without insurance) and the price at an alternate pharmacy (the alternate pharmacy can be mail order). athenaOne displays these prices when they are available from the pharmacy benefit manager or vendor.

 

To see the price that a patient can expect to pay for a medication before sending the order to the pharmacy:

  1. In the Exam stage of an encounter, locate the Assessment & Plan section.
    Note: You can also create an order from an order group or from the Orders and Results section of the Intake stage of an encounter.
  2. Click the plus icon next to Diagnoses & Orders.
  3. Search for and select the medication.
    Note: Real-time prescription price estimates are available for structured medication orders only (all Sig and Quantity fields must be filled in).

  4. Click the order to open it and expand the details.
    Estimated pricing information appears at the bottom of the order.

    Note: You may see a notification that the medication you are prescribing requires a prior authorization. You can create an electronic prior authorization request after you sign the order (see Electronic Prior Authorization (ePA) for Prescriptions).
  5. Price estimate — Review the prescription cost with the patient.
  6. If more alternatives appears below the price estimate, you can click the link to display alternatives to the prescribed medication. (If no information is available, two dashes (--) appear in the column.)
    • Medication — Shows the medication on order in gray and alternative medications in blue.
    • Insurance — Shows the price the patient would pay with insurance.
    • Cash — Shows the price the patient would pay without insurance.
      Note: athenaOne displays a cash price only if it is available from the vendor or pharmacy benefit manager.
    • Alt. Pharmacy — Shows the price the patient would pay at an alternate or mail order pharmacy. Hover the cursor over a price to see the name of the alternate pharmacy and the medication quantity.
      Note: The Alt. Pharmacy price can be for the same quantity ordered or for a maintenance supply of 3x the ordered quantity.
  7. To change the medication and pharmacy on the order, click the price in the Alt. Pharmacy column.
  8. After you and the patient agree on the medication and the price, complete the order and sign it.
  9. To create an electronic prior authorization request for the order, see Electronic Prior Authorization (ePA) for Prescriptions.