Background
Real-time benefit tools (RTBTs) represent a federally mandated innovation designed to enhance clinicians’ ability to discuss and consider medication costs at the point of prescribing. Embedded within electronic health records (EHRs), these applications display patient-specific out-of-pocket costs for prescribed medications alongside lower-cost therapeutic alternatives when applicable. Cost-related barriers to medication adherence are widely recognized in clinical medicine, especially in primary care, where patients often manage complex polypharmacy regimens. Consequently, improving medication cost transparency through RTBTs holds promise for enabling more compassionate, cost-conscious prescribing decisions tailored to individual patient financial contexts. However, the dynamics of primary care—with compressed, multifaceted visits—raise concerns that RTBT integration might inadvertently increase clinical workload or confusion if not optimally designed and implemented.
Study Design
This qualitative descriptive study sought to elucidate primary care providers’ (PCPs) experiences and attitudes toward RTBT use. Conducted across primary care clinics affiliated with two large academic health systems, it included PCPs — both physicians and advanced practice providers — who had at least one year of clinical practice experience and access to an RTBT integrated within their shared EHR platform. Semistructured interviews inquired about several key domains: attitudes toward medication cost transparency, RTBT training received, actual experience of RTBT utilization during patient care, and perceived impact on clinical decision-making and administrative workflow.
Thematic analysis was employed to synthesize interview transcripts, providing rich, provider-centric insights into the practical benefits and challenges encountered with RTBT deployment.
Key Findings
Among 35 interviewed PCPs (the majority physicians and female, with extensive practice experience), three major thematic patterns emerged:
1. Insufficient RTBT Training and Openness to Further Education
Most participants reported minimal prior education or formal training on RTBT functionalities or integration strategies. Despite this, there was a noticeable openness and desire for more structured training to improve familiarity and effective utilization of RTBTs during routine clinical encounters. PCPs recognized a learning curve associated with the new technology and sought clear guidance to optimize its use.
2. Potential Benefits: Enhanced Cost Conversations and Reduced Administrative Burden
PCPs generally viewed RTBTs as promising tools to facilitate transparent, informed discussions about medication costs. Several providers recognized that having actionable cost information readily available within the clinical workflow could foster greater patient engagement and trust through empowered shared decision-making. Additionally, RTBTs were perceived to have the capacity to decrease administrative tasks, such as time-consuming prior authorization processes or manual benefit investigations, potentially streamlining patient care.
3. Limitations and Pitfalls Hindering Optimal RTBT Use
Significant barriers were underscored that impeded routine RTBT adoption. These included incomplete or outdated medication pricing information, inaccuracies in out-of-pocket cost estimates, and suggestions for alternative medications that were sometimes clinically inappropriate. Providers expressed frustration when lower-cost alternatives presented by RTBTs did not align with clinical judgment or patient-specific needs, reducing trust in the tool. Furthermore, the additional time required to navigate these issues compounded the already limited consultation time in primary care settings.
Expert Commentary
This study sheds critical light on the current developmental stage of RTBTs: while their conceptual potential to enhance cost-conscious care is well-appreciated by frontline providers, realizing such benefits requires robust improvements in data accuracy, clinical relevance, and user-centered design. The findings resonate with prior literature identifying the importance of integrating cost information seamlessly without adding cognitive or time burdens to clinicians. Experts emphasize that collaboration among EHR developers, insurers, and clinicians is necessary to refine RTBT algorithms and interfaces, ensuring recommendations reflect contemporary formularies and heterogeneous patient clinical contexts.
Moreover, the reported desire for enhanced training highlights a need not only for technical instruction but also for educational initiatives that empower clinicians to incorporate cost discussions effectively within the complex dynamics of primary care visits.
Limitations
This qualitative study was conducted at two academic-affiliated health systems using the same EHR platform, which may limit the generalizability of findings to other clinical settings or EHR vendors. Additionally, participant self-selection and socially desirable responses may influence reported attitudes and experiences.
Conclusion
Real-time benefit tools represent a promising advance with the potential to foster compassionate, cost-aware prescribing in primary care. However, current implementation challenges—such as limited training, incomplete cost information, and clinically incongruent suggestions—impede maximal utility and clinician engagement. For RTBTs to fulfill their intended role as time-saving aids facilitating patient-centered care, enhancements in data accuracy, clinical appropriateness, and seamless integration within primary care workflows are essential. Stakeholders including EHR developers and insurers must collaborate to ensure RTBTs provide actionable, reliable information that enhances rather than burdens frontline providers.
Further research addressing patient outcomes and scalability across diverse healthcare environments will be valuable to guide refinement and broader adoption of RTBTs in clinical practice.
Reference
Kane RM, Morton-Oswald S, Lokhnygina Y, Maciejewski ML, Sloan CE. User-Directed vs Interruptive Real-Time Benefit Tools for Medication Changes in Primary Care. JAMA Netw Open. 2026 Jun 1;9(6):e2615767. doi: 10.1001/jamanetworkopen.2026.15767. PMID: 42223940; PMCID: PMC13227306.
