JAMA Netw Open. 2025 Jul 1;8(7):e2519038. doi: 10.1001/jamanetworkopen.2025.19038.
ABSTRACT
IMPORTANCE: Real-time prescription benefit (RTPB) tools provide point-of-care information for clinicians at the time of prescribing and may reduce prescription costs for patients and payers.
OBJECTIVE: To assess trends in prescription use and spending among Medicare Advantage beneficiaries at a national health insurer during the first year of clinician access to an RTPB tool.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study used 2018 to 2020 administrative data from a national insurer to compare prescription fills for beneficiaries receiving prescriptions from clinicians at practices with an RTPB tool with fills prescribed by clinicians without access to the tool. Trends in prescription spending and fills in the year after practices adopted an RTPB tool (in March 2019) were measured using a difference-in-differences design. Data were analyzed from November 2022 to June 2024.
EXPOSURE: Access to an RTPB tool within a national electronic health record software vendor.
MAIN OUTCOMES AND MEASURES: The main outcomes were total prescription spending, beneficiary out-of-pocket spending, and number of prescription fills. Secondary outcomes included percentage of fills with the insurer-owned mail-order pharmacy, percentage of fills with a 90-day supply, and subgroup analyses in drug classes appearing most frequently in the RTPB tool and high-cost prescription drug classes.
RESULTS: The sample included 2 805 060 beneficiaries (mean [SD] age 70.9 [9.2] years; 56.7% female; 14.7% Black individuals; 80.5% White individuals), with mean (SD) monthly out-of-pocket costs of $29.1 ($90.4), total prescription costs of $213.2 ($1066.3), and 2.6 (2.1) prescription fills per month. After introduction of the RTPB tool, there was no change in prescription spending (estimated out-of-pocket spending change, 1.2% [95% CI, -0.7% to 3.0%]; estimated total prescription spending change, 0.5% [95% CI: -0.2% to 1.2%]) or number of prescription fills (estimated change, 0.01 [95% CI, -0.01 to 0.02]) among beneficiaries prescribed medication by clinicians at practices with the RTPB tool.
CONCLUSIONS AND RELEVANCE: In this cohort study of 2.8 million patients, simply providing clinicians access to a RTPB tool was not associated with the anticipated benefits to patients and payers in the first year the tool was released. Further research on how to design and deploy RTPB tools to maximize potential benefits is needed.
PMID:40608336 | DOI:10.1001/jamanetworkopen.2025.19038
