Prescription Real-Time Benefit Tools: Clinicians Receive Frequent Alerts Yet Rarely Accept The Suggested Changes.

Health systems are increasingly integrating real-time benefit tools into their electronic health records (EHRs). These tools are designed to improve the affordability of and adherence to medications by alerting clinicians to out-of-pocket prescription price estimates and lower-price alternatives. Clinicians' engagement with real-time benefit tools is critical to the tools' success, yet it has not been comprehensively examined. Using 2019-22 EHR data from 803 ambulatory clinics and 4,894 clinicians in a large health system, we found that clinicians received a median of 19 alerts per 100 orders; of the 87 percent of clinicians who received at least one alert, 91 percent changed an order in response to an alert at least once. Clinicians made changes in response to 11 percent of all alerts they received, but they rarely accepted the alternatives originally suggested by the tool. Changes most often involved the pharmacy (60 percent), followed by quantity (39 percent), formulation (6 percent), and medication (4 percent). Primary care clinicians received the most alerts per month, while medical and surgical subspecialists made changes for a larger share of alerts. For these tools to be successfully implemented, leaders must consider the quality and usability of alerts, time burdens, and alert fatigue.