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Implementation and cost validation of a real-time benefit tool.

Shiven Bhardwaj¹, Steven D Miller, Amanda Bertram

¹The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, School of Pharmacy, University of Washington, 1959 NE Pacific St, Box 357630, Seattle, WA 98195-7630.

The American Journal of Managed Care

|October 17, 2022

Summary

The National Council for Prescription Drug Programs (NCPDP) real-time benefit tool (RTBT) accurately estimates patient prescription costs. Most patients experienced lower or equivalent out-of-pocket expenses compared to RTBT estimates.

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Area of Science:

Health Informatics
Health Economics
Pharmacy Practice

Background:

Real-time benefit tools (RTBTs) aim to improve prescription cost transparency.
Assessing RTBT accuracy is crucial for patient financial planning and medication adherence.

Purpose of the Study:

To evaluate the accuracy of an NCPDP-compliant RTBT in an academic medical center.
To analyze medication order modifications and out-of-pocket cost estimations.

Main Methods:

Observational study utilizing electronic health and pharmacy records.
Analysis of patient demographics, prescription changes, and cost comparisons.
Data collected from July 2019 to January 2020 across ambulatory clinics and outpatient pharmacies.

Main Results:

Medication order modifications frequently involved changes in days' supply (44%) and quantity (69%).
Over 98% of prescriptions had out-of-pocket costs matching or lower than RTBT estimates.
RTBT use demonstrated high accuracy in predicting patient financial responsibility.

Conclusions:

NCPDP standards for RTBTs provide accurate patient out-of-pocket cost estimates.
These accurate estimates have the potential to become a national standard for Medicare Part D sponsors.
RTBTs can enhance medication cost transparency and potentially improve patient access to medications.