Real-Time Prescription Benefit Check Lowers Out-of-Pocket Costs

Real-time prescription benefit (RTPB) recommendations reduced out-of-pocket costs for patients, especially for those prescribed high-cost medications. Researchers published their findings in JAMA Internal Medicine.

“Rising drug costs contribute to medication nonadherence and adverse health outcomes,” said Sunita M Desai, PhD, affiliated with the NYU School of Medicine, and coinvestigators. “[RTPB] systems present prescribers with patient-specific out-of-pocket cost estimates and recommend lower-cost, clinically appropriate alternatives at the point of prescribing.”

Researchers conducted a cluster randomized trial in which providers in a large, urban, academic health system implemented RTPB recommendations for adults treated in the outpatient setting. The study was conducted from January 13, 2021, to July 31, 2021, and researchers carried out analyses between August 20, 2021, and June 8, 2022, using electronic health record (EHR) data.

After providers entered a prescription in the EHR, the RTPB system recommended lower-cost alternatives which included different medications, prescription lengths, and pharmacy options. The prescriber was then free to choose the initial prescription or one of the recommended alternatives.

Out of 867,757 total outpatient prescriptions, there were 36,419 (4.2%) with alternative options. The RTPB intervention yielded out-of-pocket costs of $39.90 for a 30-day supply, compared to $67.80 for patients whose prescriptions were not run through the system.

Of note, RTPB recommendations reduced out-of-pocket costs by 11.2% overall (95% CI, -15.7% to -6.4%) and 38.9% for high-cost drugs specifically (95% CI, -47.6% to -28.7%).

The intervention did not affect rates of 90-day supply, and mail order pharmacy use was similar between groups, at “9.6% and 7.6% in the intervention and control groups, respectively (adjusted 1.9 percentage point increase; 95% CI, 0.9 to 3.0).”

“This cluster randomized clinical trial showed that RTPB recommendations led to lower patient out-of-pocket costs, with the largest savings occurring for high-cost medications. However, RTPB recommendations were made for only a small percentage of prescriptions,” study authors concluded.

Reference:
Desai SM, Chen AZ, Wang J, et al. Effects of real-time prescription benefit recommendations on patient out-of-pocket costs: A cluster randomized clinical trial. JAMA Intern Med. Published online September 12, 2022. doi:10.1001/jamainternmed.2022.3946