User-Directed vs Interruptive Real-Time Benefit Tools for Medication Changes in Primary Care

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One-third of US adults struggle with medication affordability, impacting adherence, especially among those with multimorbidity.
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Real-time benefit tools (RTBTs) provide clinicians with patient-specific medication cost estimates and alternatives at the point of prescription.
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RTBTs are required for Medicare Part D plans since 2021 and will be mandatory in all EHRs by 2028, yet clinician engagement remains low.
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Duke Health modified its RTBT from user-directed to interruptive, automatically displaying cost estimates when savings exceed $2.00.
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The study aims to assess the impact of RTBT design changes on clinician engagement and medication order adjustments in primary care.

Jama Network Open

by Ryan M. Kane, Sarah Morton-Oswald, Yuliya Lokhnygina, Matthew L. Maciejewski, Caroline E. Sloan
June 1, 2026

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