Sunita Desai, PhD
NYU Grossman School of Medicine
"Real-time prescription benefit (RTPB) tools are EHR-integrated decision-support systems that deliver patient-specific drug cost information and recommend lower-cost, clinically equivalent alternatives at the moment of prescribing — an early example of digital innovation aimed at making clinical workflows more cost-conscious and equitable. Despite growing adoption and federal mandates for Medicare Part D integration, rigorous causal evidence on their real-world effects remains limited.
We conducted two analyses using data from a cluster randomized trial across 255 outpatient practices at NYU Langone Health (2021), in which practices were randomized to RTPB recommendations or usual care. The first examined effects on out-of-pocket costs (n=36,419 eligible orders); the second examined prescription fill rates (n=38,289), stratified by drug class cost and patient income.
RTPB reduced out-of-pocket costs by 11% overall and nearly 40% in the highest-cost drug classes. Overall fill rates were unchanged, but in the highest-cost drug classes, RTPB increased fill rates by 14.5 percentage points (95% CI: 8.4, 20.6). Gains were largest among patients from the lowest-income communities, where fill rates rose by 28.4 percentage points, compared to no meaningful change in higher-income groups.
Digital tools that embed actionable information directly into clinical workflows can meaningfully reduce financial barriers to care — but impact depends on targeting and context. These finding"
We conducted two analyses using data from a cluster randomized trial across 255 outpatient practices at NYU Langone Health (2021), in which practices were randomized to RTPB recommendations or usual care. The first examined effects on out-of-pocket costs (n=36,419 eligible orders); the second examined prescription fill rates (n=38,289), stratified by drug class cost and patient income.
RTPB reduced out-of-pocket costs by 11% overall and nearly 40% in the highest-cost drug classes. Overall fill rates were unchanged, but in the highest-cost drug classes, RTPB increased fill rates by 14.5 percentage points (95% CI: 8.4, 20.6). Gains were largest among patients from the lowest-income communities, where fill rates rose by 28.4 percentage points, compared to no meaningful change in higher-income groups.
Digital tools that embed actionable information directly into clinical workflows can meaningfully reduce financial barriers to care — but impact depends on targeting and context. These finding"
