UPMC Health Plan


Jeffrey Davis
UPMC Health Plan

UPMC Announces Patient-centered Initiative to Reduce Out-of-Pocket Prescription Drug Costs for UPMC Health Plan Members

UPMC physicians will be able to help UPMC Health Plan members with greater affordability and optimal drug selection

Pittsburgh (July 21, 2020) – UPMC, a world-renowned health care organization that includes UPMC Health Plan, the largest health insurer in western Pennsylvania, implemented a new technology in partnership with RxRevu to enable its physicians to help patients lower prescription drug costs based upon their insurance coverage. By giving UPMC physicians real-time access to a patient’s benefit levels through UPMC Health Plan, doctors can consider lower-cost alternatives when writing prescriptions. In addition to potentially lower costs, patients can also avoid delays associated with obtaining prior authorizations needed for certain prescriptions.

“This really is about getting the script right the first time by having physicians view a patient’s insurance benefits in real-time to make informed decisions,” said Chronis Manolis, RPh, Senior Vice President, Pharmacy and Chief Pharmacy Officer for UPMC Health Plan. “By enabling this technology, we are ushering in a new era of transparency of information at the point of prescribing to allow the physician and patient to have a more informed, shared conversation and decision about a treatment plan. This will be a useful tool to help patients avoid delays and save on out-of-pocket prescription costs.”

UPMC and UPMC Health Plan operate as an integrated delivery and finance system (IDFS), improving the outcomes and experiences of patients and members by seamlessly integrating the clinical and payor experiences. Using SwiftRx® Direct, a real-time prescription benefit developed by RxRevu, UPMC physicians will have an enhanced ability to view patient-specific coverage information, formulary-driven alternatives, and lower-cost drug options during office visits. The drug pricing data that the physicians see is a true representation of what that patient would be asked to pay out-of-pocket at the pharmacy.

“Our physicians now have information transparency in real-time, enabling true shared decision-making with our patients while they are still in the exam room, and before the patient goes to the pharmacy,” said Robert Bart MD, Chief Medical Information Officer for UPMC. “This means fewer surprises for our patients at the pharmacy counter and lower overall health care costs.”

“Our objective is to create more informed and valuable interactions between patients and providers,” said Kyle Kiser, President and Chief Strategy Officer at RxRevu. “People trust their provider to guide them to the right prescription decision. Our technology ensures providers have the most accurate information available, so that they can choose the lowest-cost medication option in real-time. With patient-specific information presented at the point-of-care, we are reducing friction and improving the health care experience for both patients and care teams."

Manolis concluded: “By displaying patient-specific cost and drug coverage information within our prescription decision process, at the point of care, we enable physicians to prescribe the right medications that our members can afford. This enhances the overall patient and physician experience and aligns with our value-based philosophy by providing data transparency in real-time.”


About UPMC Insurance Services

UPMC Insurance Services is owned and operated by UPMC, a world-renowned health care provider and insurer based in Pittsburgh, Pa. UPMC Insurance Services—which includes UPMC Health Plan, Workpartners, UPMC for Life, UPMC for You, UPMC for Kids, and Community Care Behavioral Health"—offers a full range of health insurance and benefit management services including Medicare, Special Needs, Children’s Health Insurance, Medical Assistance, Behavioral Health, Employee Assistance and Workers' Compensation products and services to over 3.9 million members. For more information, visit www.upmchealthplan.com.

About UPMC

A $21 billion health care provider and insurer, Pittsburgh-based UPMC is inventing new models of patient-centered, cost-effective, accountable care. The largest nongovernmental employer in Pennsylvania, UPMC integrates more than 90,000 employees, 40 hospitals, 700 doctors’ offices and outpatient sites, and a 3.9 million-member Insurance Services Division, the largest medical insurer in western Pennsylvania. In the most recent fiscal year, UPMC contributed $1.4 billion in benefits to its communities, including more care to the region’s most vulnerable citizens than any other health care institution, and paid more than $500 million in federal, state, and local taxes. Working in close collaboration with the University of Pittsburgh Schools of the Health Sciences, UPMC shares its clinical, managerial, and technological skills worldwide through its innovation and commercialization arm, UPMC Enterprises, and through UPMC International. U.S. News & World Report consistently ranks UPMC Presbyterian Shadyside on its annual Honor Roll of America’s Best Hospitals and ranks UPMC Children’s Hospital of Pittsburgh on its Honor Roll of America’s Best Children’s Hospitals.For more information, go to UPMC.com.

About RxRevu

RxRevu is a Denver-based company on a mission to improve healthcare through more informed, consistent, and frictionless prescription decisions. RxRevu’s Prescription Decision Support technology promotes condition-appropriate prescribing and patient cost transparency to improve safety and satisfaction. The SwiftRx® platform helps clinicians quickly and easily find affordable alternatives to more costly medications specific to a patient’s health needs and out of pocket cost. It also enables health systems to holistically manage and measure clinicians prescribing performance. For more information about RxRevu, its solutions and innovative advancements, visit rxrevu.com.