Department of Population Health, NYU Grossman School of Medicine, New York, New York.
Oscar Health, New York, New York.
JAMA Intern Med. 2022 Nov 1;182(11):1129-1137. doi: 10.1001/jamainternmed.2022.3946.
Rising drug costs contribute to medication nonadherence and adverse health outcomes. Real-time prescription benefit (RTPB) systems present prescribers with patient-specific out-of-pocket cost estimates and recommend lower-cost, clinically appropriate alternatives at the point of prescribing.
To investigate whether RTPB recommendations lead to reduced patient out-of-pocket costs for medications.
DESIGN, SETTING, AND PARTICIPANTS: In this cluster randomized trial, medical practices in a large, urban academic health system were randomly assigned to RTPB recommendations from January 13 to July 31, 2021. Participants were adult patients receiving outpatient prescriptions during the study period. The analysis was limited to prescriptions for which RTPB could recommend an available alternative. Electronic health record data were used to analyze the intervention's effects on prescribing. Data analyses were performed from August 20, 2021, to June 8, 2022.
When a prescription was initiated in the electronic health record, the RTPB system recommended available lower-cost, clinically appropriate alternatives for a different medication, length of prescription, and/or choice of pharmacy. The prescriber could select either the initiated order or one of the recommended options.
Patient out-of-pocket cost for a prescription. Secondary outcomes were whether a mail-order prescription and a 90-day supply were ordered.
Of 867 757 outpatient prescriptions at randomized practices, 36 419 (4.2%) met the inclusion criteria of having an available alternative. Out-of-pocket costs were $39.90 for a 30-day supply in the intervention group and $67.80 for a 30-day supply in the control group. The intervention led to an adjusted 11.2%; (95% CI, -15.7% to -6.4%) reduction in out-of-pocket costs. Mail-order pharmacy use was 9.6% and 7.6% in the intervention and control groups, respectively (adjusted 1.9 percentage point increase; 95% CI, 0.9 to 3.0). Rates of 90-day supply were not different. In high-cost drug classes, the intervention reduced out-of-pocket costs by 38.9%; 95% CI, -47.6% to -28.7%.
This cluster randomized clinical trial showed that RTPB recommendations led to lower patient out-of-pocket costs, with the largest savings occurring for high-cost medications. However, RTPB recommendations were made for only a small percentage of prescriptions.
ClinicalTrials.gov Identifier: NCT04940988; American Economic Association Registry: AEARCTR-0006909.
不断上涨的药品成本导致患者用药依从性降低和健康状况恶化。实时处方福利（RTPB）系统为开处方的医生提供了患者特定的自付费用估算，并在开处方时推荐更便宜、临床更合适的替代方案。
研究 RTPB 建议是否会降低患者的药物自付费用。
设计、地点和参与者：在这项集群随机试验中，大型城市学术医疗系统中的医疗实践被随机分配接受 RTPB 建议，时间为 2021 年 1 月 13 日至 7 月 31 日。参与者为在研究期间接受门诊处方的成年患者。分析仅限于 RTPB 可以推荐可用替代方案的处方。电子健康记录数据用于分析干预措施对处方的影响。数据分析于 2021 年 8 月 20 日至 2022 年 6 月 8 日进行。
当电子健康记录中开出处方时，RTPB 系统会针对不同的药物、处方长度和/或药房选择，推荐可用的更便宜、临床更合适的替代方案。开处方的医生可以选择启动订单或推荐的选项之一。
处方的患者自付费用。次要结果是是否开了邮购处方和 90 天的供应量。
在随机实践中，867757 名门诊患者中，有 36419 名（4.2%）符合有可用替代方案的纳入标准。干预组的 30 天供应量自付费用为 39.90 美元，对照组为 67.80 美元。干预导致自付费用降低了 11.2%（95%CI，-15.7%至-6.4%）。邮购药房的使用率分别为干预组的 9.6%和对照组的 7.6%（调整后增加 1.9 个百分点；95%CI，0.9 至 3.0）。90 天供应量的比例没有差异。在高成本药物类别中，干预措施降低了 38.9%的自付费用；95%CI，-47.6%至-28.7%。
这项集群随机临床试验表明，RTPB 建议可降低患者的自付费用，高成本药物的节省幅度最大。然而，RTPB 建议仅适用于一小部分处方。
ClinicalTrials.gov 标识符：NCT04940988；美国经济协会注册处：AEARCTR-0006909。
