Implementation and cost validation of a real-time benefit tool

Abstract

Objectives: To assess the accuracy of a real-time benefit tool (RTBT) that is compliant with the standards of the National Council for Prescription Drug Programs (NCPDP) in a large academic medical center.

Study design: Observational study of electronic health records and pharmacy records from July 14, 2019, through January 14, 2020, across all ambulatory clinics and outpatient pharmacies in the health system.

Methods: Main assessments included (1) demographic characteristics of patients in whom the RTBT was used and those in whom it was not used, (2) types of changes most frequently made to medication orders upon reviewing the RTBT, and (3) comparison of the out-of-pocket costs for prescriptions vs the RTBT-generated estimates.

Results: The most common modifications made to prescriptions due to RTBT use were changes in days' supply (44%) and the quantity of medication (69%). In more than 98% of prescription orders, patients' out-of-pocket costs were either equivalent to or lower than the estimates generated by the RTBT.

Conclusions: Current standards established by NCPDP yield accurate patient out-of-pocket estimates and could serve as a national standard for all Part D sponsors.