2024 MIPS IA_BE_25: Drug Cost Transparency

Activity ID

Activity Weighting

Subcategory Name

Beneficiary Engagement

Activity Description

Provide counseling to patients and/or their caregivers regarding: costs of medications using a real time benefit tool (RTBT) which provides to the prescriber real-time patient-specific formulary and benefit information for drugs, including cost-sharing for a beneficiary.

Objective

Help patients navigate the stress and risks associated with paying for healthcare by providing information on the patients’ share of the costs for medications in the drug formulary; help patients explore alternative options that address their holistic needs.

Suggested Documentation

Documented provision of counseling to patients and/or their caregivers regarding the costs of medications using the Real-Time Benefit Tool (RTBT). Include both of the following elements:

1) Use of RTBT – Evidence of RTBT used in practice (e.g., workflow diagram, screenshot of tool) to provide real-time patient-specific formulary and benefit information for medications, including cost-sharing for a beneficiary and counselling on medication costs; AND

2) Discussion of alternative medications and assistance programs – Documentation (e.g., EHR or medical record note) of discussion/counseling with patients about the availability of any alternative medications (such as generics) and the patients’ eligibility for patient assistance programs that provide free medications for patients who are unable to afford to buy their medicine. For this activity, patient assistance programs pertain to patients who require assistance to purchase necessary medications

Example/Information

• Real-time benefit tool (RTBT): www.covermymeds.com/main/insights/rtbcscorecard/
• Patient Assistance Program Center: www.rxassist.org/providers