Researchers analyzed the impact of real-time prescription benefits on prescribing patterns by evaluating subsequent fill rates and copay costs.
After implementing real-time prescription benefits (RTPB), researchers saw significant improvements in prescription fill rates as well as a decrease in copay costs for patients, according to data from a study published in the American Journal of Health-System Pharmacy (AJHP).1 Researchers’ results highlight the ability of RTPB tools to improve patient adherence, medication affordability, and health care delivery.
“Prescribers often seek ways to reduce patient out-of-pocket expenses for prescriptions and increase medication adherence. However, patients frequently encounter high costs and/or lengthy delays due to prior authorization (PA) in obtaining their medications,” wrote authors of the study.1
A new approach has been recognized for patients to experience savings and receive more focused attention and care at the pharmacy counter. The real-time prescription benefits, or RTPB, approach “shows prescribers patient-, medication-, and pharmacy-specific information on how much a medication is estimated to cost, whether there are any PA requirements, and lower-cost therapeutic alternatives,” continued the authors.
Offering patients a more transparent view of how their prescription benefits are distributed, the RTPB tool has the potential to give patients an expanded scope of options, clearly defining most aspects of how a prescription medication is dispensed. While transparency has oftentimes arose as an issue amongst drug manufacturers, insurance plan sponsors, and pharmacy benefit managers (PBMs), RTPB is designed to put the transparency back into drug dispensing and for patients to have a firmer grasp on understanding their prescription benefits.
Real-time prescription benefits show prescribers patient-, medication-, and pharmacy-specific information. | image credit: Dragana Gordic / stock.adobe.com
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Several reports and studies have slammed PBMs for their lack of transparency when facilitating prescription drug benefits. From patients and clinicians to insurance plan sponsors, several parties have reported that PBMs often conceal financial transactions and move drugs to different formularies with no explanation, often driving up prices and eliminating access to life-saving medications.2
Furthermore, according to a July Federal Trade Commission (FTC) report, “PBMs oversee these critical decisions about access to and affordability of life-saving medications, without transparency or accountability to the public,” wrote authors of the report.3
However, despite the recent public scrutiny towards PBMs, authors of the AJHP study credited a PBM for its findings within the RTPB model.
“One PBM found that, when prescribers were shown an alert about [PA] requirements or lower-cost alternatives, they would commonly switch to a covered alternative. The same PBM reported that RTPB, when implemented successfully, was able to save patients $120 to $130 per fill on average, when switching to a lower-cost alternative,” they wrote.1
From March 2022 to 2023, researchers analyzed the prescribing patterns of 446,064 patients who received well over 2 million prescriptions. After sending patients alerts for PA updates, or when alternative medications became available for cost savings, researchers’ key observations were alert acceptance rates and the prescription fill rates of participants. The secondary outcome was the monthly copay savings yielded for participants who accepted alerts.
The results of RTPB at the pharmacy counter were significantly successful across the board, saving participants money and giving back the transparency that has been lacking within the distribution of prescription benefits.
“RTPB requests received a response for 88% of prescriptions, with price estimates provided for 77.9% of them. Lower-cost alternatives accounted for 67.2% of alerts, while [PA] requirements represented 15% of alerts,” continued authors of the study.1 When lower-cost alternatives were available, prescribers offered them to patients 32% of the time. For patients receiving RTPB alerts, they filled prescriptions 68% of the time compared with 59% of filled prescriptions for patients receiving the original prescription.
Finally, addressing the secondary outcome of the study, patients received an average of $27.77 in copay cost savings each month when alternative medications were selected. Amidst ongoing issues of drug pricing and access, results of this study highlight a promising look to the future of benefits distribution within the pharmaceutical industry.
“The ability to provide real-time prices and alternative medications at the point of prescribing empowers providers to make more informed decisions about their patients’ treatment plans. These findings highlight the potential of RTPB programs as valuable tools to promote patient adherence, medication affordability, and efficient health care delivery,” concluded the authors.1
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