Impacts of a Physician-targeted Price Transparency Tool on Medication Out-of-pocket Costs

Impacts of a Physician-targeted Price Transparency Real Time Prescription Benefits Tool on Medication Out-of-pocket Costs

The goal of this study is to evaluate whether presenting patient out-of-pocket cost information to the provider at the time of prescribing leads to orders for medications with lower out-of-pocket costs. The Real-Time Prescription Benefits (RTPB) tool has been implemented to randomly selected providers across NYU Langone Health's outpatient physician practices. The RTPB tool provides physicians with information about patient out-of-pocket (OOP) cost for medications at the point of outpatient prescribing. OOP is inclusive of any copay, coinsurance, and deductible that the patient owes given their prescription drug benefit plan. If the physician is submitting a prescription order and a clinically-appropriate alternative with a lower OOP cost is available, an alert with OOP cost information for the drug being initially ordered as well as up to three lower-cost alternatives will be displayed. Implementation of this tool will be analyzed to see if it will lead to reduced out-of-pocket costs on ordered medications when alternatives were available. Because effects could vary along many dimensions (e.g., specialty, drug class, insurance type), secondary analyses will be conducted and stratified along such dimensions. Analyses will be conducted at the prescription order level.

Study Overview

• Status: Completed
• Conditions: Costs and Cost Analysis; Prescriptions
• Intervention / Treatment: Other: Real-time benefits check

• Study Type: Observational
• Enrollment (Actual): 21401

Contacts and Locations

Study Locations

• United States
  • New York
    • New York, New York, United States, 10016
      • NYU Langone Health

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 100 years (Adult, Older Adult)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

• Sampling Method: Probability Sample

Study Population

The intervention group refers to medication orders placed by prescribers when practicing in an outpatient department randomly assigned to receive the intervention, which is implementation of the RTPB tool. The control group refers to medication orders placed by prescribers when practicing in an outpatient department randomly selected to not receive the intervention.

Description

Inclusion Criteria:

• Medication orders for which this match and query was successful and outcomes data was available.

Exclusion Criteria:

• No patient-level exclusion criteria will be imposed

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
See alert; The intervention group refers to medication orders placed by prescribers when practicing in an outpatient department randomly assigned to receive the intervention, which is implementation of the RTPB tool.	Other: Real-time benefits check; Prescribers practicing in outpatient departments assigned to the intervention arm will be shown popup alerts with their patient's insurance benefit design-specific out-of-pocket cost for the drug being ordered as well as out-of-pocket costs for up to 3 lower-cost alternatives if available. Alternatives will only be shown when available and when the patient and his or her benefit design information can be matched by the electronic health record system to accurately query out-of-pocket cost information.; Other Names: Physician-focused medication price transparency
Do not see alert; The non intervention group refers to medication orders placed by prescribers when practicing in an outpatient department randomly selected to not receive the intervention.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Medication out of pocket cost per day	The primary outcome, which will be measured at the medication-order level is out-of-pocket cost per day for a drug ordered. It will be computed by dividing the out-of-pocket cost of a drug by the days supply. Data will be collected through the electronic health record.	Through study completion, an average of 1 year

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Whether an order was placed for a mail-order pharmacy	A secondary outcome, also specified at the order level, is whether a drug prescription was ordered from a mail-order pharmacy, since switching to a mail-order pharmacy often presents an opportunity for savings. Data will be collected through the electronic health record.	Through study completion, an average of 1 year
Days supply	A secondary outcome, also specified at the order level, is the days supply. Data will be collected through the electronic health record.	Through study completion, an average of 1 year

Collaborators and Investigators

• Sponsor: NYU Langone Health

Publications and helpful links

General Publications

• Desai SM, Chen AZ, Wang J, Chung WY, Stadelman J, Mahoney C, Szerencsy A, Anzisi L, Mehrotra A, Horwitz LI. Effects of Real-time Prescription Benefit Recommendations on Patient Out-of-Pocket Costs: A Cluster Randomized Clinical Trial. JAMA Intern Med. 2022 Nov 1;182(11):1129-1137. doi: 10.1001/jamainternmed.2022.3946.

Study record dates

Study Major Dates

• Study Start (Actual): November 18, 2020
• Primary Completion (Actual): July 30, 2021
• Study Completion (Actual): July 30, 2021

Study Registration Dates

• First Submitted: March 18, 2021
• First Submitted That Met QC Criteria: June 18, 2021
• First Posted (Actual): June 28, 2021

Study Record Updates

• Last Update Posted (Actual): September 16, 2021
• Last Update Submitted That Met QC Criteria: September 14, 2021
• Last Verified: September 1, 2021

More Information

Terms related to this study

• Other Study ID Numbers: QI-RTPB

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No