The Impact of Real-Time Benefits Physician-Targeted Price Transparency on Patient Out-of-Pocket Costs

Last registered on March 31, 2021

Pre-Trial

Trial Information

General Information

Title
The Impact of Real-Time Benefits Physician-Targeted Price Transparency on Patient Out-of-Pocket Costs
RCT ID
AEARCTR-0006909
Initial registration date
January 04, 2021

Initial registration date is when the trial was registered.

It corresponds to when the registration was submitted to the Registry to be reviewed for publication.

First published
January 04, 2021, 8:46 AM EST

First published corresponds to when the trial was first made public on the Registry after being reviewed.

Last updated
March 31, 2021, 6:38 AM EDT

Last updated is the most recent time when changes to the trial's registration were published.

Locations

Region

Primary Investigator

Affiliation
NYU School of Medicine

Other Primary Investigator(s)

PI Affiliation

Additional Trial Information

Status
On going
Start date
2021-01-13
End date
2021-06-10
Secondary IDs
I10, I12, I18
Abstract
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. We implement a real-time benefits check (RTBC) tool to randomly selected providers across NYU Langone Health’s outpatient physician practices. The RTPC tool provides physicians with information about patient out-of-pocket (OOP) cost for medications at the point of outpatient prescribing. 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. We will analyze whether implementation of this tool led to reduced out-of-pocket costs on ordered medications.
External Link(s)

Registration Citation

Citation
Desai, Sunita and Leora Horwitz. 2021. "The Impact of Real-Time Benefits Physician-Targeted Price Transparency on Patient Out-of-Pocket Costs." AEA RCT Registry. March 31. https://doi.org/10.1257/rct.6909-1.2000000000000002
Experimental Details

Interventions

Intervention(s)
The goal of the real-time benefits check (RTBC) tool is to facilitate prescribing of lower-cost alternatives by providing patient out-of-pocket cost information to physicians at the point of prescribing. RTBC is developed through a partnership between Surescripts and Epic.
For a subset of prescriptions ordered RTBC 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 and information is specific to the patient's prescription drug benefit plan. If the physician is submitting a prescription order and a clinically-appropriate alternative with a lower out-of-pocket cost is available, an alert with out-of-pocket cost information for the drug being ordered as well as up to three lower-cost alternatives will be displayed. The physician can then prescribe the original drug or one of the alternative drugs.
Intervention Start Date
2021-01-13
Intervention End Date
2021-06-10

Primary Outcomes

Primary Outcomes (end points)
out-of-pocket cost per day
Primary Outcomes (explanation)
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.

Secondary Outcomes

Secondary Outcomes (end points)
Whether an order was placed for a mail-order pharmacy
Days supply
Whether lowest cost option was prescribed
Secondary Outcomes (explanation)
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

Days supply: Since increasing the days supply for a prescription is a margin on which savings could occur, we will also test for changes in the days supply of an order

Experimental Design

Experimental Design
Departments across NYU Langone Health's outpatient faculty practices will be randomized to being shown out-of-pocket cost alerts at the time of prescribing or not.
Experimental Design Details
Randomization Method
Randomization done in an office by a computer
Randomization Unit
Randomization by department. Randomization will be stratified by broad clinical specialty categories
Was the treatment clustered?
Yes

Experiment Characteristics

Sample size: planned number of clusters
908 departments
Sample size: planned number of observations
28,221
Sample size (or number of clusters) by treatment arms
Treatment arm: 567 departments (2514 physicians) ; Control arm: 660 departments (2663 physicians)
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
Our power calculation was based on a 5% effect size, based on effects found in the literature on price transparency for medical services.
IRB

Institutional Review Boards (IRBs)

IRB Name
IRB Approval Date
IRB Approval Number
Analysis Plan

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Post-Trial

Post Trial Information

Study Withdrawal

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Intervention

Is the intervention completed?
No
Data Collection Complete
Data Publication

Data Publication

Is public data available?
No

Program Files

Program Files
Reports, Papers & Other Materials

Relevant Paper(s)

Reports & Other Materials