Researchers addressed the current trends in prescription drug use and spending among Medicare Advantage beneficiaries during the first year of clinician access to a real-time prescription benefit tool.
In the first year of use for the real-time prescription benefit (RTPB) tool, researchers uncovered no association with the anticipated benefits of patients and payers, according to a study published in JAMA Network Open.1 They suggest further research is necessary to better understand how RTPB tools can be designed and deployed to maximize benefits.
“Despite wide variation in medications costs used to treat the same condition, point-of-care information on prescription drug costs is limited for both patients and clinicians,” wrote authors of the study. “The lack of real-time insight into costs at the time of prescribing may result in patients facing high out-of-pocket (OOP) costs for prescribed drugs despite the presence of lower-cost, medically appropriate alternatives.”
For many years, experts and researchers alike have been deliberating on the best models for delivering clinical services and prescription medications. All leading to a complex system of insurers, payers, patients, and providers, understanding the methods of prescription drug benefits takes more than just some general knowledge.
Researchers compared the differential changes in participants’ beneficiary outcomes for patients whose physicians were either using or not using the RTPB tool. | image credit: sornram / stock.adobe.com
READ MORE: How the Complexities, Trends in Drug Benefit Design Are Evolving in Real Time
First, it’s important to understand patients’ OOP costs as well as cost sharing practices among many insurers and plan sponsors. Cost sharing is the arrangement in which patients pay insurers a portion of their costs for health care services or medications. Higher cost sharing responsibilities for beneficiaries means higher OOP costs.2
“The published literature shows consistent impacts of higher cost sharing on initiation and continuation of medications, and the greater the cost sharing, the worse the medication adherence,” wrote authors of a study published in the Journal of Managed Care & Specialty Pharmacy.3 “Today’s growing cost-containment environment should carefully consider the broader impact cost sharing has on treatment adherence, clinical outcomes, resource use, and total costs.”
Integrated with a wealth of data from the electronic health record (EHR), RTPB tools are used to ensure that stakeholders seeking a prescription medication can do so without the timely process of cross-checking formularies and comparing alternative options.4 In other words, it is a database that updates in real time with a variety of medication options for the necessary patient populations.
However, despite these recent technological advancements within pharmacy, as of late 2021, the American Medical Association claimed that RTPB technology was incomplete and needed optimization.4
“Our study leveraged the introduction of an RTPB tool in a national EHR vendor in March 2019 to study trends in prescription fills,” wrote authors of the current study.1 “Using data from the tool in combination with pharmaceutical and medical claims data for Medicare Advantage (MA) beneficiaries at a nationwide health insurer, we used a difference-in-differences (DID) approach to estimate changes in prescription use and spending for beneficiaries filling prescriptions from clinicians at practices with the RTPB tool vs clinicians at practices without the tool.”
Researchers compared the differential changes in participants’ beneficiary outcomes either attributed or not attributed to practices with the RTPB tool. Using the DID approach, they sought out trends in prescription drug spending and fills prescribed by physicians in the year after the RTPB tool was adopted. Data from 2018 to 2020 were used for the study and were analyzed from November 2022 to June 2024.
The final analysis included a total of 2,805,060 MA beneficiaries (mean age, 70.9 years; 56.7% women).
“We found no change in prescription spending, number of fills, or percentage of prescriptions filled with the insurer’s mail-order pharmacy after the introduction of an RTPB tool,” they continued.1 “Although we detected a small but significant change in log prescription spending among lipid-modifying agents, more broadly, our subgroup analyses detected minimal to no significant changes in antidepressants, lipid-modifying agents, or high-cost fills.”
With the RTPB feature being a novel technology for physicians, pharmacists, and patients, the results of this study may not be significantly surprising to some experts. While the lack of change in this study can possibly be owed to physicians not using the tool enough, collectively furthering patient and provider knowledge of the RTPB will only reduce barriers to cost-effective prescription drug data.
“In this cohort study of 2.8 million patients, we found no change in prescription spending after the introduction of an RTPB tool, likely due to underuse of the tool in the EHR,” concluded the authors.1 “RTPB tools have the potential to address physician behavior as a mechanism for lowering prescription drug spending, but our findings highlight the importance of leveraging the design of price transparency tools like RTPB to reduce barriers to accessing the information.”
READ MORE: Public Health Resource Center
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