Real-time Prescription Benefit Tools—The Promise and Peril

Everson, Jordan; Dusetzina, Stacie B.

doi:10.1001/jamainternmed.2022.3962

Cited by 7 publications

(5 citation statements)

References 5 publications

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“…Unfortunately, the implementation of real-time benefit tools is challenged by potentially incomplete data (eg, interoperability challenges between prescription drug plan data from insurers and electronic health records), 23,24 and the accuracy of these tools is unclear. Real-time benefit tool estimates are meant to be specific to a patient, pharmacy, and time, and if a patient waits to fill a prescription or chooses to go to a different pharmacy, their medication price can be different.…”

Section: Discussionmentioning

confidence: 99%

Cost-Related Medication Nonadherence and Desire for Medication Cost Information Among Adults Aged 65 Years and Older in the US in 2022

et al. 2023

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ImportanceRising prescription drug costs and increasing prices for consumer goods may increase cost-related medication nonadherence. Cost-conscious prescribing can be supported by real-time benefit tools, but patient views on real-time benefit tool use and their potential benefits and harms are largely unexplored.ObjectiveTo assess older adults’ cost-related medication nonadherence, cost-coping strategies, and views on the use of real-time benefit tools in clinical practice.Design, Setting, and ParticipantsA weighted, nationally representative survey of adults aged 65 years and older administered via the internet and telephone from June 2022 to September 2022.Main Outcomes and MeasuresCost-related medication nonadherence; cost coping strategies; desire for cost conversations; potential benefits and harms from real-time benefit tool use.ResultsAmong 2005 respondents, most were female (54.7%) and partnered (59.7%); 40.4% were 75 years or older. Cost-related medication nonadherence was reported by 20.2% of participants. Some respondents used extreme forms of cost-coping, including foregoing basic needs (8.5%) or going into debt (4.8%) to afford medications. Of respondents, 89.0% reported being comfortable or neutral about being screened before a physician's visit for wanting to have medication cost conversations and 89.5% indicated a desire for their physician to use a real-time benefit tool. Respondents expressed concern if prices were inaccurate, with 49.9% of those with cost-related nonadherence and 39.3% of those without reporting they would be extremely upset if their actual medication price was more than what their physician estimated with a real-time benefit tool. If the actual price was much more than the estimated real-time benefit tool price, nearly 80% of respondents with cost-related nonadherence reported that it would affect their decision to start or keep taking a medication. Furthermore, 54.2% of those with any cost-related nonadherence and 30% of those without reported they would be moderately or extremely upset if their physicians used a medication price tool but chose not to discuss prices with them.Conclusions and RelevanceIn 2022, approximately 1 in 5 older adults reported cost-related nonadherence. Real-time benefit tools may support medication cost conversations and cost-conscious prescribing, and patients are enthusiastic about their use. However, if disclosed prices are inaccurate, there is potential for harm through loss of confidence in the physician and nonadherence to prescribed medications.

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Section: Discussionmentioning

confidence: 99%

Cost-Related Medication Nonadherence and Desire for Medication Cost Information Among Adults Aged 65 Years and Older in the US in 2022

et al. 2023

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“…27 While outside of the scope of the study, it has been reviewed elsewhere with noted advantages and disadvantages. 27,28 Future research may consider comparing alternative approaches with DMCI workflow to determine which tool provides more accurate and comprehensive information. In addition, with a larger sample size, the impact of these interventions on improving adherence, duration of hospitalization, and cost could be further explored via multivariable analysis.…”

Section: Discussionmentioning

confidence: 99%

Impact of a Standardized, Pharmacist-Initiated “Test-Claim” Workflow for Anticipating Barriers to Accessing Discharge Antimicrobials

Mulugeta,

MacDonald,

El-Khoury

et al. 2023

Journal of Pharmacy Technology

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Background: Inability to access and afford discharge oral antimicrobials may delay discharges or result in therapeutic failure. “Test-claims” have the potential to identify such barriers. Objective: This study evaluated discharge antimicrobial access and patient outcomes after implementation of a standardized, inpatient pharmacist-initiated antimicrobial discharge medication cost inquiry (aDMCI) process. Methods: This was an Institutional Review Board (IRB)-approved, pilot retrospective cohort study that included adults admitted for ≥72 hours from November 1, 2018, to February 28, 2019, and discharged on oral antimicrobials. Patients with a cost inquiry (aDMCI group) were compared with those without (standard-of-care, SOC, group). Primary endpoint was discharge delay. Secondary endpoints included percentage of patients discharged on suboptimal antimicrobials and medication errors from aDMCI. Results: 84 patients were included: 43 in SOC and 41 in aDMCI. Seventy-five antimicrobial cost inquiries were evaluated among 41 patients. There were no discharge delays or medication errors associated with the standardized “test-claim” (aDMCI) workflow. Patients in the SOC group had a greater Charlson Comorbidity Index (4 [2-6] vs 2 [1-4], P =0.004), were more likely to be immunosuppressed (24, 56% vs 12, 29%; P =0.014), and had longer hospitalization (8 [5-15] vs 6 [5-9] days, P =0.026). Primary access barriers were prior-authorization (8, 11%) and associated with linezolid and moxifloxacin cost inquiries. Most aDMCIs results were available in <24 hours (66, 88%). Conclusions: The aDMCI process is safe and offers an actionable transition of care tool that can identify barriers to accessing discharge medications while insulating patients from surprise out-of-pocket cost.

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“…Previous research demonstrates that when providers are made aware of patient costs, they are more cost‐conscious when making clinical decisions 17 . Though some health‐systems have implemented software aimed at increasing visibility of medication costs, these predictions do not always provide accurate or real‐time data 18–20 . The American Medical Association and physicians have encouraged implementing price transparency into the EHR, so long as it is meaningful and actionable 17,21 .…”

Section: Discussionmentioning

confidence: 99%

“…17 Though some healthsystems have implemented software aimed at increasing visibility of medication costs, these predictions do not always provide accurate or real-time data. [18][19][20] The American Medical Association and physicians have encouraged implementing price transparency into the EHR, so long as it is meaningful and actionable. 17,21 Given the high cost of many maintenance inhalers limits patient access to therapy, ensuring that prescribed inhaler therapy is covered by insurance and affordable to patients prior to discharge could reduce primary and secondary nonadherence 22 and improve patient satisfaction.…”

Section: Inhaler Therapy Recommendationsmentioning

confidence: 99%

Pharmacist review of chronic inhaler therapy appropriateness for hospitalized patients with COPD or asthma

Parrott,

Wallace,

Niehoff

et al. 2023

J Am Coll Clin Pharm

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Patients with asthma and chronic obstructive pulmonary disease rely on inhaler therapy to reduce disease progression and exacerbation risk. Patients admitted to the hospital are at an increased risk for exacerbations and readmission if their inhaler therapy upon discharge is not aligned with current guidelines and/or affordable. The objective of this study was to assess the appropriateness of the chronic inhaler regimen for patients admitted to the hospital based on clinical practice guidelines and insurance coverage. A sub‐study was designed to analyze a cohort of a single‐center, pragmatic, prospective randomized controlled trial at a large academic medical center. Patients admitted to a medicine service with a pharmacist and prescribed a long‐acting inhaler were included. Participants randomized to a pharmacist‐led intervention were assessed for inhaler appropriateness based on clinical guidelines and patient insurance. The objective of this sub‐study is to assess the number of inhalers identified as inappropriate based on the pharmacist's review. A patient was considered to have an inappropriate inhaler regimen if any of their inhalers were inconsistent with guideline recommendations or not covered by insurance. Descriptive statistics were used to characterize appropriate inhaler use. The study pharmacist reviewed 552 unique inhalers for 348 patients. Overall, 42% of inhalers were inappropriate, affecting 50.3% of participants; 20% of inhalers were inappropriate based on insurance, 26% were inappropriate based on guidelines, and 7% were inappropriate based on both criteria. Recommendations were placed via a pharmacy consult for 198 patients (57%), most recommending an inhaler initiation (55%), followed by inhaler discontinuation (38%). A pharmacist‐led review of chronic inhaler therapy for patients admitted to the hospital identified the need for a change in therapy based on financial or clinical guidelines in over half of the patients reviewed. Interventions to increase the appropriateness of prescribed inhalers are needed to reduce disease progression and disease exacerbation.

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Real-time Prescription Benefit Tools—The Promise and Peril

Abstract: et al. Offering a price transparency tool did not reduce overall spending among California public employees and retirees.

Cited by 7 publications

References 5 publications

Cost-Related Medication Nonadherence and Desire for Medication Cost Information Among Adults Aged 65 Years and Older in the US in 2022

Cost-Related Medication Nonadherence and Desire for Medication Cost Information Among Adults Aged 65 Years and Older in the US in 2022

Impact of a Standardized, Pharmacist-Initiated “Test-Claim” Workflow for Anticipating Barriers to Accessing Discharge Antimicrobials

Pharmacist review of chronic inhaler therapy appropriateness for hospitalized patients with COPD or asthma

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