According to a 2020 report in Bloomberg, Americans spend an average of $1,200 annually on prescription drugs. Compared to other countries, what differs for Americans is the high prices of those medications, which can lead to the abandonment of prescriptions at the pharmacy or to patients taking less of the medicine than prescribed. Traditionally, healthcare providers had no way of knowing how much the medicines they were prescribing would actually cost individual patients at the pharmacy. But that is in the process of changing, thanks to a new type of technology being integrated into electronic health records (EHRs), called Real-Time Prescription Benefit (RTPB) tools.
Through a grant from The Patrick and Catherine Weldon Donaghue Medical Research Foundation, a team from Yale School of Medicine (YSM) and Yale New Haven Health (YNHHS) will partner with researchers from the Johns Hopkins University School of Medicine and Froedtert & Medical College of Wisconsin health network to evaluate the impact of RTPB tools on prescribers and patients.
Beginning in 2021, the Centers for Medicare and Medicaid Services has mandated that many insurance plans incorporate RTPB tools in EHRs. These tools will assess a patient’s eligibility to receive the medication, along with providing out-of-pocket costs and/or appropriate alternative medications. The prescriber can use this information to discuss costs with the patient or switch to a lower-cost therapy.
“These tools are meant to provide prescribers with an opportunity for discussing and addressing costs and barriers to medication adherence with their patients,” said Jeremy Schwartz, MD, associate professor of medicine (general medicine).
The researchers will assess the impact and utilization of RTPB tools across three large and diverse health systems and investigate facilitators and barriers to prescriber adoption over a two-year period. Their goal is to establish methods to measure the impact of the tool nationally and to identify areas for improvement learned from these three institutions with early RTPB implementation. Schwartz added, “Through this work, we hope to understand how the technology is being used currently within YNHHS and the other health systems, and to generate evidence that helps health systems improve RTPBs in ways that are locally relevant to their patient populations.”
The YSM/YNHHS team consists of Schwartz; Arian Schulze, communications lead, Equity Research and Innovation Center (ERIC); Nitu Kashyap, MD, associate chief medical information officer, YNHHS; Jing Liu, data analytics management specialist, YNHHS; Richard Hintz, manager, Joint Data Analytics Team, YSM; and Tanvi Mehta, Yale University undergraduate student.
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