Impact of Real-Time Benefit Tools on Patients’ Access to Medications: A Retrospective Cohort Study

Authors: 

Shiven Bhardwaj, Jessica W. Merrey, Martin A. Bishop, Hsin-Chieh Yeh, Jeremy A. Epstein  

Publication: 

American Journal of Medicine, July 2022 

Unfortunately, it is all too common that clinicians may unwittingly order medications that their patients struggle to afford. When faced with such prices, patients may decline to pick up medications from their pharmacies. For some, this may delay care as prescribers attempt to identify and prescribe affordable alternatives. Other patients may be left with limited or no access to needed medication.  

Recognizing the lack of prescription price transparency, the Centers for Medicare and Medicaid Services (CMS) issued a ruling on May 16, 2019, requiring Part D plans to incorporate formulary and out-of-pocket cost information within Real-Time Benefits Tools (RTBT).  

A recent study published in the American Journal of Medicine and sponsored by NPC and the Pharmacy Quality Alliance sought to evaluate the impact of this potential solution to address the barriers to access and care. This work measures the impact of Real-Time Benefit Tools (RTBT) on the ability of patients to obtain their prescribed medications.  

Real-time benefit tools (RTBT) are enhancements within electronic health records (EHRs), that seek to prevent the adverse health outcomes that stem from the unintentional prescribing of medications by allowing providers insight, during the health care encounter, of the out-of-pocket costs to the patient of proposed medications and that of any alternatives. The RTBT aims to improve transparency in this process by allowing insight into the patient’s prescription drug plan benefit with its specific medication formulary as well as any copays and prior authorization requirements.  

Although this rule would presumably increase the transparency of medication costs for patients, concerns have been raised about this requirement, given the challenges with RTBT design and implementation, as well as the lack of existing evidence demonstrating their capacity to meaningfully change clinical practice or patient outcomes. This study sought to evaluate whether any incremental cost savings potentially achieved through these tools result in tangible benefits to patients. 

The study sample included 10,676 orders; 55% were prescribed without RTBT use, and 45% were prescribed with RTBT use.  To our knowledge, this study is the first to date to evaluate the effect of RTBT use on patients. Researchers found that prescriptions ordered using the RTBT were more likely to be filled by patients rather than abandoned at the pharmacy or canceled by their provider. The use of RTBT was not associated with any change in the 30-day prescription modification rate.  

In conclusion, RTBT use was associated with a marked increased rate of prescription obtainment by patients. Although only one institution’s experience, this study highlights the potential benefit of RTBTs. Considering these benefits, health policy efforts should be undertaken to promote the expansion of these tools. As RTBTs require compatibility with prescription drug plans and integration into EHRs, growth in both domains is essential to achieve their full potential. Further research is needed to investigate the impact of RTBTs on clinical outcomes and to establish best practices to facilitate end-user adoption. The next generation of RTBTs could facilitate broader patient access to their prescribed medication with improved functionality.