Impact of a real-time prescription benefit on adherence and utilization of low-cost prescription alternatives for members new to diabetes treatment.

Abstract

Background: Chronic diseases such as diabetes are a major burden to the US health care system. High medication adherence helps improve diabetes outcomes and reduce cost. Cost of medications can contribute to nonadherence. Use of a formulary decision support system with e-prescribing may be associated with greater use of generic medications, leading to lower costs and better adherence. A real-time prescription benefit (RTPB) solution provides patient-specific drug pricing, benefit information, and therapeutic options to choose the most cost-effective and clinically appropriate treatment.

Objectives: To examine whether RTPB is associated with increased adherence measured by proportion of days covered, higher utilization of generics, and generic dispensing rate? Is RTPB associated with lower plan and patient out-of-pocket (OOP) per-user per-month costs?

Methods: This study used a retrospective, matched intervention-control analysis of commercial health plan members from a large pharmacy benefits manager. Members were eligible for inclusion if they initiated therapy between January and August 2021. Members were excluded if they were not continuously eligible for coverage over the study period. Members who initiated diabetes therapy with a prescriber using RTPB (intervention) were compared with those new to therapy with a prescriber not using RTPB (control). Index date for both samples was the first medication prescription in the index period. Members were matched on age and sex demographics. The evaluation period lasted 12 months after index date. Multivariable linear regression models were used to assess the impact of an RTPB program on adherence and proportion of prescriptions filled with a generic. A generalized linear model (gamma distribution, log link) estimated plan and OOP patient costs, whereas a generalized linear model model with the Poisson distribution was used to estimate the number of controlling for patient age, sex, social determinants of health score, and other patient- and plan-level covariates.

Results: 1,302 matched pairs were included in the analysis. Findings show the proportion of days covered was 68.7% for control and 71.4% for RTPB members (P < 0.05). The average number of generic prescriptions for control and RTPB samples were 4.06 and 5.66, respectively (P < 0.05) and the generic dispensing rates were 44.9% and 60.1%, respectively (P < 0.05). The mean plan cost per member per month for diabetes medications, for the non-RTPB group, was 32.3% higher than the RTPB sample (a difference of $81.69, P < 0.0001) and the mean patient cost per month was 88.8% higher than the RTPB sample (a difference of $9.71, P < 0.0001).

Conclusions: Access to RTPB tools provides prescribers with formulary benefit and therapeutic options that allow them to provide the lowest-cost clinical treatment, thus improving adherence, increasing use of generic medications, and lowering plan and patient OOP costs.