Real-Time Benefit Tools and Their Place in Cost-Conscious Prescribing

Rising prescription prices often result in patients using cost-coping measures and non-adherence to treatment plans.  Real-time benefit tools can help patients and physicians in navigating cost-conscious treatments, however, patient’s views on these tools have not been fully assessed. A study recently published in JAMA Open Network, led by Stacie Dusetzina, PhD, and coauthored by Professor of Health Care Policy, Nancy Keating, MD, MPH, considers patient views on the implementation of real-time benefit tools.

The study used a weighted, nationally representative survey of adults aged 65 years and older administered via the internet and telephone from June 2022 to September 2022 to measure cost-related medication nonadherence; cost coping strategies; desire for cost conversations; potential benefits and harms from real-time benefit tool use. Results showed that cost-related medication nonadherence was reported by 20% of participants, with some respondents using extreme forms of cost-coping, such as sacrifice of basic needs, and going into debt to afford medications.

The authors employed a composite of 5 questions to indicate whether the respondent or someone in their household exhibited evidence of the following forms of cost-related nonadherence to save money on their prescription medications: decided not to fill a prescription, skipped medication doses, took less medicine, delayed filling a prescription, or used someone else’s medication. About one-fifth of respondents reported at least one of these types of cost-related nonadherence

The study also measured medication cost-coping activities reported by respondents, such as copayment cards, requests for lower-cost medication or free samples, comparison shopping for pharmacy discounts, pursuit of financial assistance, and purchasing prescriptions from another country. They additionally considered further coping strategies including spending less money on food, heat, or other basic needs to have money for medicine and borrowing money or going into debt to help with prescription medication costs. More than half of respondents reported experiencing any cost-coping strategy.

Most respondents reported being comfortable with being screened before physician’s visits about their interest in having a conversation about the cost of their medications, and indicated a desire for their physician to use a real-time benefit tool if it resulted in more cost-efficient treatment. However, respondents expressed concern if prices were inaccurate, reporting they would be extremely upset if their actual medication price was more than the cost predicted by a real-time benefit tool, and stating that it would affect their decision to start or keep taking a medication.

As prescription drug affordability becomes an increasingly pressing issue, it is important to recognize the measures patients need to take to afford treatment. Real-time benefit tools might offer support in medication cost conversations and cost-conscious prescribing, and patients are enthusiastic and open to their use. However, accuracy of disclosed prices is essential to ensure patient confidence and continued adherence to treatment.