“Worth it if you could afford it”: Patient perspectives on integrating real‐time benefit tools into drug cost conversations

Abstract

Background Medication costs can lead to financial burdens for patients, creating barriers to effective medication use. Health care provider use of real‐time benefit tools (RTBTs) may facilitate cost conversations with patients. We sought to explicate patient views on how RTBTs could be used to improve cost considerations in prescribing decisions. Methods We conducted focus groups to characterize patient perspectives on holding cost conversations with their physicians and to identify factors that would influence the value of RTBTs. We focused on adults aged 50+ who reported trouble paying for their prescriptions. Three groups included patients with conditions requiring high‐cost treatments and one group included lower‐income patients independent of their medical conditions. Focus groups were recorded, transcribed, coded, and categorized to salient themes employing inductive and deductive approaches using the Health Equity Implementation Framework. Results Focus groups were conducted from 09/2020–12/2020 including 18 participants representing cancer (n = 6), diabetes (n = 6), rheumatoid arthritis (n = 3), and lower income (n = 3). Participants were between 50–74, eight self‐identified as Black, 10 as White, and eight reported earning <$50,000/year. We identified five themes regarding cost conversations (medication cost importance, past experiences with cost/cost conversations, perception of physician's role and knowledge, knowledge of existing resources, and influence on decision‐making) and four RTBT‐use‐specific themes (advantages/disadvantages, perceived relevance, data quality concerns, and implementation considerations). Conclusion Approaches that envision RTBTs as one‐size‐fits‐all technological interventions may underestimate the complexity of incorporating price information into prescribing decisions. Nevertheless, patients highlighted the potential value of accurate, real‐time information on medication costs to inform decision‐making.

Patients want to talk about their out‐of‐pocket costs—Can real‐time benefit tools help?

“…The authors conducted qualitative interviews with a diverse group of patients to evaluate their views of cost‐of‐care conversations and the role that RTBTs might play in facilitating them. The findings from this article, as well as the same group's previously published article on clinicians' perspectives of RTBTs, 4,15 suggest that several important actions should be taken to ensure that RTBT use is practical and helps improve patient care, especially for complex patients like Ms. Smith.…”

“…Both patients and clinicians worry that RTBT use will prolong clinical encounters and/or take time away from other important clinical matters. 4,15 Prior analyses of audio-recorded encounters have found that cost-of-care conversations typically last only 1 or 2 min, 17 but these analyses were conducted prior to the existence of RTBTs. Now that real-time cost information is available, cost-ofcare conversations may take longer and be more nuanced as clinicians and patients discuss the tradeoffs of various medications with varying cost, efficacy, and side effect profiles.…”

“…Inaccurate cost estimates could damage patients' trust in their physicians. 4 Only one study so far has evaluated the accuracy of RTBT cost estimates. In that study, Bhardwaj and colleagues compared RTBT estimates in one health system to the amount that patients actually paid for their medications.…”

“…But based on a national survey of US physicians, over three quarters would likely get some aspect of that calculation wrong. 3 As shown by Mattingly and colleagues, 4 many patients with chronic medical conditions want access to accurate cost information as well as compassionate cost-of-care conversations with their clinicians. This is an important patient population with a significant need for accurate cost information.…”

“…Costs were 11.2% lower (95% CI À15.7%, À6.4%) for medication orders sent from clinics randomized to RTBT alerts. 14 The accompanying article by Mattingly and colleagues 4 is the first to qualitatively assess patient perspectives on real-time out-of-pocket price transparency tools. The authors conducted qualitative interviews with a diverse group of patients to evaluate their views of costof-care conversations and the role that RTBTs might play in facilitating them.…”