Access to affordable medications is a major concern for many patients in the United States. Rising healthcare costs and high copayments often leave individuals struggling to afford their medical care. This issue is particularly significant for those with chronic conditions like diabetes and high blood pressure, who rely on regular medication to manage their conditions effectively. In an effort to address this problem, Real-Time Benefit Tools (RTBTs) have been introduced to provide clinicians with price estimates for medications, allowing them to assess the affordability of prescribed drugs for their patients. This article examines the impact of these tools on clinician decision-making and explores potential barriers to their utilization.
RTBTs have the potential to revolutionize the way clinicians prescribe medications, particularly for patients with private insurance or Medicare. By integrating price estimates into electronic health records (EHRs), clinicians can access real-time information on copayments, deductibles, and preferred pharmacies, enabling them to make more informed decisions about medication choices. Additionally, these tools can alert clinicians to lower-cost alternatives that may exist, providing practical solutions to reduce patient costs. With access to this invaluable information, clinicians can play a vital role in helping patients navigate the complexities of medication affordability.
A recent study conducted at a large academic health system sought to understand the influence of RTBTs on medication prescribing by primary care providers (PCPs). Over a three-year period, 889 PCPs received price estimates for 181,887 medication orders. Surprisingly, the study found that PCPs changed their orders only 12% of the time when alerted to the existence of a lower-cost alternative. However, further analysis revealed that PCPs were more likely to change their orders when the potential cost savings were substantial.
For example, PCPs changed their medication orders 11% of the time when cost savings were $5 or less, but this percentage increased to 16% when the potential savings exceeded $20. These findings suggest that while PCPs are responsive to significant cost-saving opportunities, they may be less inclined to pursue changes when the potential savings are relatively small.
Several factors may contribute to the underutilization of RTBTs in clinical practice. One primary barrier may be the timing of price estimate alerts during a patient visit. These alerts typically appear when a clinician is already in the process of signing a medication order, potentially disrupting the flow of the visit and causing clinicians to hesitate in exploring alternative options. Given the time constraints of primary care visits, clinicians may be reluctant to introduce a completely new medication option and risk falling behind schedule.
Another factor that may impede utilization is the sheer volume of alerts that clinicians receive. When inundated with numerous alerts, clinicians may not fully acknowledge or even ignore them. This phenomenon has been observed in prior studies. To address this issue, developers of RTBTs should consider optimizing the design and logic of these tools to focus on medicines where patient price information holds the greatest relevance. By tailoring the alerts to specific medications, providers can be more attuned to the potential cost-saving opportunities and minimize disruptions to clinical workflows.
Moreover, a significant missed opportunity lies in the assumption that small cost savings are not of concern to patients or that patients may overlook them. While 71% of RTBT alerts reported potential savings of $5 or less per prescription, assuming that patients are indifferent to such savings overlooks their financial struggles and underestimates the importance of even modest savings. Clinicians must recognize the value of every dollar saved, as these savings can accumulate and make a substantial difference for patients over time.
Additionally, skepticism among clinicians regarding the accuracy and appropriateness of the price estimates may contribute to their dismissal of alternative options. Clinicians may question whether the suggested alternatives align with the patient’s current condition or stage of disease, leading them to disregard the suggestions altogether. To overcome this barrier, efforts should be made to enhance the accuracy and relevance of the price estimates provided by RTBTs. Building trust in the information presented will foster greater confidence among clinicians in utilizing these tools to guide their prescribing practices.
The integration of Real-Time Benefit Tools into clinical practice represents a significant stride towards increasing price transparency and improving patient access to affordable medications. However, there are challenges to their effective utilization that must be addressed. Understanding the factors that influence clinician decision-making and exploring ways to optimize the design and implementation of these tools is crucial. By leveraging the potential of RTBTs, healthcare providers can play an active role in mitigating the financial burdens faced by patients, ensuring that their medication needs are met without compromising other aspects of their well-being. Taking these essential steps will pave the way for a more equitable and accessible healthcare system.
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