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

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.