In today’s healthcare system, many patients face the challenge of affording their prescribed medications. High costs and limited insurance coverage often force individuals to make difficult choices regarding their healthcare. Real-Time Benefit Tools (RTBTs) have emerged as a potential solution to this problem, providing clinicians with price estimates and lower-cost alternatives for medications. However, a recent study conducted at a large academic health system revealed that clinicians are not taking full advantage of these tools to address patients’ financial constraints. This article examines the findings of the study and explores the factors that contribute to the underutilization of RTBTs.
Patients with chronic conditions, such as diabetes or hypertension, often depend on multiple medications to manage their health. However, the cost of these medications can be a significant barrier to adherence and overall wellness. Even with insurance coverage, copays and deductibles may be burdensome for many individuals. As a result, patients may be forced to skip or reduce their medication intake, compromising their health outcomes.
To address the issue of medication affordability, CMS mandated that Medicare drug plans provide price estimates to prescribing clinicians starting in 2021. RTBTs were introduced as a means for clinicians to access real-time pricing information for medications based on patients’ specific pharmacy coverage, copays, and deductibles. These tools are integrated into electronic health records (EHRs), allowing clinicians to make informed decisions regarding medication selection and cost management.
Despite the potential of RTBTs to assist clinicians in reducing patient costs, the study found that clinicians only changed their medication orders in response to RTBT alerts 12% of the time. This low percentage suggests a missed opportunity to improve patient access to affordable care. Several factors contribute to this underutilization:
1. Timing and Visit Constraints
RTBT alerts typically appear when clinicians are in the process of signing a medication order. At this point, a clinician has likely already discussed the benefits and risks of the selected medication with the patient. The limited time available for primary care visits may discourage clinicians from exploring alternative options and potentially disrupting the visit schedule. However, the study also revealed that clinicians who independently searched for RTBT price estimates earlier in the visit were three times more likely to change their medication orders. This finding highlights the importance of integrating RTBTs into the workflow to maximize their effectiveness.
2. Alert Fatigue
Busy clinicians may experience alert fatigue when faced with numerous notifications from RTBTs or other health information systems. Previous studies have shown that excessive alerts can lead to diminished attention and even disregard of important information. Addressing alert fatigue and ensuring that clinicians receive meaningful and relevant alerts is crucial to promoting the use of RTBTs.
3. Perception of Cost Savings
A significant percentage of RTBT alerts indicated cost savings of $5 or less per prescription. While these savings may be substantial when viewed collectively, some patients and clinicians may not consider them significant enough to warrant a change in medication orders. This perception of minimal cost impact may result in the dismissal of RTBT alerts without further consideration. Educating patients about the cumulative benefits of cost savings and encouraging clinicians to discuss these alerts with patients could improve awareness and utilization of RTBTs.
4. Lack of Confidence in Price Estimates
Some clinicians may question the accuracy and appropriateness of the price estimates provided by RTBTs. Concerns about patients’ specific conditions or disease stage may lead clinicians to dismiss the suggested lower-cost alternatives. Building trust and confidence in the accuracy of RTBTs’ price estimates among clinicians is essential to enhance their adoption and utilization.
Real-Time Benefit Tools have the potential to improve patient access to affordable medications by providing clinicians with price estimates and identifying lower-cost alternatives. However, the underutilization of these tools represents a missed opportunity to address patients’ financial barriers to care. By addressing timing constraints, alert fatigue, perception of cost savings, and clinician confidence in price estimates, healthcare organizations can enhance the adoption and effectiveness of RTBTs. Improving medication affordability is a vital step towards achieving equitable healthcare outcomes and ensuring patients can access the medications they need to manage their health effectively.
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