As patients, we often face the challenge of affording our medical care, especially when it comes to costly prescription medications. The rising costs of healthcare in the United States have led many individuals to skip or cut back on their medications. In response to this issue, Real-Time Benefit Tools (RTBTs) have emerged as a potential solution to help clinicians and patients navigate the complexities of medication costs and find lower-cost alternatives. This article examines the impact of RTBTs on medication orders and explores the factors that influence clinician decision-making.
The Need for Price Transparency
Access to accurate information about medication prices is crucial for patients and clinicians alike. It allows patients to make informed decisions about their healthcare and helps clinicians consider the financial implications of their prescribing choices. Traditionally, patients with insurance faced challenges in determining the exact copays for their medications. However, since 2021, Medicare drug plans in many large health systems have been required to provide price estimates to prescribing clinicians through RTBTs. These tools are integrated into electronic health records (EHRs), enabling clinicians to access price information in real-time during patient visits.
The Potential of RTBTs
RTBTs offer clinicians a valuable opportunity to better understand their patients’ medication costs and identify practical solutions to reduce expenses. These tools not only provide price estimates for specific medications but also offer information about lower-cost alternatives within the same drug class or formulations. By leveraging RTBTs, clinicians can adjust medication orders to optimize cost savings for their patients. Previous research has shown that clinicians feel a moral and professional obligation to help patients mitigate the financial burden of their medications. RTBTs provide a platform for clinicians to fulfill this obligation by finding lower-cost options and ensuring affordable access to necessary treatments.
A Closer Look at Clinician Response to RTBT Alerts
To evaluate the impact of RTBTs on clinician decision-making, a study was conducted at a large academic health system. Over a period of three years, 889 primary care providers (PCPs) were alerted with price estimates for 181,887 medication orders via RTBTs. The study found that PCPs changed their medication orders in only 12% of the cases when alerted by RTBTs. However, closer analysis revealed that PCPs were more likely to modify their orders when the potential cost savings for patients were higher.
Several factors may contribute to the low rate of medication order modifications by PCPs. Firstly, RTBT alerts were often presented at the stage of medication order signing, which occurred towards the end of the patient visit. Given the time constraints of primary care visits, clinicians may be hesitant to explore entirely new medication options and potentially fall behind schedule. However, the study found that PCPs who independently looked up RTBT price estimates earlier in the visit were almost three times more likely to change their orders, suggesting the importance of timing in the decision-making process.
Secondly, alert fatigue may play a role in the limited response to RTBTs. If clinicians receive excessive alerts, they may overlook or disregard them, leading to missed opportunities for cost optimization. Additionally, the study highlighted that 71% of RTBT alerts would have saved patients $5 or less. While these savings may seem insignificant to some patients, they could accumulate to substantial amounts when viewed collectively. PCPs may assume that patients are not concerned with saving a few dollars per prescription and, therefore, dismiss the price alerts without discussion, representing a missed opportunity to improve patient access to care.
Lastly, some clinicians may question the accuracy or appropriateness of the price estimates presented by RTBTs, leading them to dismiss the suggestions. This suggests the need for concise and reliable price information that aligns with the patient’s current condition or disease stage.
The integration of RTBTs into EHRs marks a significant advancement in the journey towards greater price transparency in healthcare. Patients and clinicians have expressed a desire for access to medication price information, as it helps address concerns about affordability and allows for informed decision-making. However, it is crucial to consider the factors that influence clinician response to RTBT alerts. Understanding these factors can inform the design and logic of RTBTs, ensuring they provide maximum benefit while minimizing disruptions to clinical workflows.
Real-Time Benefit Tools have the potential to revolutionize the way clinicians and patients navigate the complexities of medication costs. While the study showed that medication order modifications were relatively low, they were more likely to occur when the potential cost savings were substantial. Timing, alert fatigue, patient perception of cost savings, and clinician trust in price estimates are key factors influencing clinician responses to RTBT alerts. By addressing these factors and refining the design of RTBTs, we can optimize medication cost optimization efforts and improve patient access to affordable care.