Real-time drug price information didn’t change physician prescription patterns
July 9, 2025
Summary: Physicians with access to a real-time drug pricing tool did not appear to substantially change their prescribing patterns, and no cost savings were observed.
Source: Zink, et al JAMA Network Open July 3, 2025 Note that all changes (second column) are just about zero, and any difference with a P value of over 0.05 is not considered statistically significant.
Physicians don’t always prescribe the most cost-effective medications, and use of more costly medications increases member cost sharing as well as plan cost. Offering patients tools to “choose” the most cost-effective medications won’t necessarily move the dial, since it’s hard for patients to contact their prescribing clinicians after a visit to request a change of drug. The health insurer Humana compared prescribing patterns of clinicians of 2.8 million members of their Medicare Advantage plans who were offered a real-time drug pricing tool integrated into their electronic medical records with clinicians who did not have such access.
The results were disappointing. Those clinicians with access to the tool did not have significant differences in changes in cost, number of fills, or use of the insurer’s mail order pharmacy compared to clinicians without such access.
What went wrong?
Clinicians had to do extra work to see the potential cost savings (click on a drop-down box), and the total savings from each suggested change was just $4 per month, which might not have been large enough to motivate physicians to change their prescribing patterns. Providers might not have trusted the accuracy of the prices, and overburdened clinicians might have been reluctant to take the time to explain to their patients why they were changing course.
I believe based on press reports that the electronic health record used was Epic Systems, although the article does not state this.
Implications for employers:
While this specific design of real time drug price decision support did not appear to change clinician behavior, improvements in design could lead to more cost-effective prescribing.
Pharmacy plans likely need to continue to use member-facing tools, including formulary and tiers, to steer toward more cost-effective pharmacy prescribing.
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Views expressed in Employer Coverage are purely my own.
This is very important, but where is the time to look into price information. There needs to be a better process. In our EMR systems, we are glued on seeing a patient and going to the next patient. The time taken to go to an another portal is impractical.
Better technology is needed!
This is no surprise. The literature on physician feedback consistent shows simple clinical and cost feedback and guidelines are not effective to change behavior.
A more successful process is to stratify the physicians and feedback to outliers their results against their peers AND give them a rationale and evidence to change.
We have successfully changed behavior in hundreds of physicians and Medicaid and the commercial sector when feeding back generic fill rates, dispenses written, cost per drug in a class and given the physicians their numbers compared to appears best in class. The addition of an evidence based newsletter, defining why changes and evidence are necessary enhances the feedback process. We find it for every 1 percent increase generic fill rate there is a 1-1.5 % reduction in overall pharmacy spend. The results are more dramatic when feeds back includes bio similar vs biologic drugs. Depending on the population age and disease categories of 50% increase in bios similars can return huge rewards without any decrement in clinical outcomes.