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Yale Researchers Address Out-of-Pocket Prescription Costs

June 06, 2023
by Sarah L. Spaulding

The increasingly prohibitive cost of prescription medications continues to pose major challenges to the U.S. health care system, leading to poor medication adherence, suboptimal clinical outcomes, and the ever-growing costs of care. Despite this, prescriber access to actionable price transparency at the point of prescription remains limited. Two recently published papers from Yale Internal Medicine researchers Jeremy Schwartz, MD, associate professor of medicine (general medicine), Yale School of Medicine (YSM), and epidemiology (chronic disease), Yale School of Public Health (YSPH), and Nitu Kashyap, MD, assistant clinical professor of medicine (general Medicine, YSM), and biostatistics, health informatics (YSPH), sought to tackle this issue.

In a narrative review published in the Journal of General Internal Medicine, their team of authors explores real-time prescription benefit (RTPB) tools, new electronic tools that provide clinicians with out-of-pocket cost information for a specific patient and medication at the point of prescribing. Kashyap, Schwartz, and their co-authors provide a comprehensive review of the fundamentals and terminology needed for clinicians to understand how RTPB tools function, how they can engage with these valuable decision support tools, and the future integration with electronic health records for widespread adoption by providers and healthcare systems. The team highlighted the importance of research on the outcomes of RTPB tool use, including medication costs, adherence, and prescribing tendencies of providers.

Their second paper seeks to fill the knowledge gap in how different health systems have implemented RTPB tools. In a cross-sectional study published in Healthcare, the researchers analyzed data on the implementation of RTPB tools at five major academic medical centers and the impact of these tools on prescribing. Results showed wide variation in implementation and use across hospitals: all but one chose to automatically display out-of-pocket cost estimates and alternative medication suggestions, and RTPB retrieval rates across medical centers ranged from 8 - 60 percent of outpatient prescriptions. The rate of prescriptions that were modified to an RTPB tool-suggested alternative ranged from 0.1 - 4.9 percent.

Schwartz commented on the significance of the work, “Since becoming a physician, I have been frustrated by the lack of transparency around out-of-pocket medicine costs to my patients. When I prescribe a medicine, I have very little idea how much the patient will have to pay at the pharmacy. Understandably, this leads to a disconnect between the prescriber and the patient. So, I have been excited to partner with colleagues from Yale and four other large academic medical centers to study these RTPB tools that, for the first time, open a window into what a particular medicine actually will cost for a particular patient and also suggest less expensive alternatives. These tools have the potential to radically alter the patient-clinician conversation around cost and access to medicines in this country.”

Kashyap agreed. “Prescription costs remain a big unknown to prescribers and have huge implications for medication compliance. Fortunately, newer technologies now allow us the ability to get an estimate of what the patient will pay at the pharmacy. While not perfect, it is an important tool for clinicians who may be making medication decisions in a cost vacuum today. We are fortunate to collaborate with organizations across the country to understand these technologies to promote adoption, and more importantly, avoid any unintentional consequences.”

In addition to Schwartz and Kashyap, collaborators on “Where Do Real-Time Prescription Benefit Tools Fit in the Landscape of High US Prescription Medication Costs? A Narrative Review” include Rachel Wong, MD, from Renaissance School of Medicine at Stony Brook; Tanvi Mehta (Yale College ’22) from Duke University School of Medicine; Bradley Very, Jing Luo, MD, MPH, and Kristian Feterik, MD, MBA, from University of Pittsburgh School of Medicine; Bradley H. Crotty, MD, MPH, and Erica Smith, PharmD, from Froedtert & the Medical College of Wisconsin Health Network; Jeremy A. Epstein, MD, and Fasika A. Woreta, MD, MPH, from Johns Hopkins University School of Medicine; and Michael J. Fliotsos, MD, from Yale New Haven Hospital.

Authors on “Implementing Real-Time Prescription Benefit Tools: Early Experiences From 5 Academic Medical Centers,” include Luo, Wong, Mehta, Schwartz, Epstein, Smith, Kashyap, Woreta, Feterik, Fliotsos, and Crotty.

The Department of Internal Medicine at Yale is among the nation's premier departments, bringing together an elite cadre of clinicians, investigators, educators, and staff in one of the world's top medical schools. To learn more, visit Internal Medicine.

Submitted by Julie Parry on June 06, 2023