Improving medication adherence and disease control for patients with multimorbidity: the role of price transparency tools

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Dr. Sloan is a general internist and health services researcher whose long-term career goal is to evaluate the effectiveness of policies and interventions that address barriers to care for older adults with multimorbidity. Many patients with multimorbidity struggle to pay for their medications. These patients have lower medication adherence, resulting in a higher risk of disease progression, functional limitations, hospitalization, and death. Patients cannot account for medication costs in their medical decisions, because they rarely know what those costs will be before getting to the pharmacy. If clinicians could access information about their patients’ medica- tion-related out-of-pocket costs at the point-of-prescribing, they could help their patients apply for financial sup- port, or prescribe lower-cost alternatives. New out-of-pocket drug price transparency tools could fill this need. The Centers for Medicare and Medicaid Services recently mandated that Medicare Part D plans make clinician- facing out-of-pocket drug price transparency tools available to clinics and hospitals via the electronic health record (EHR). No one has described the uptake and acceptability of these tools, or their impact on clinical out- comes among middle-aged and older patients with multimorbidity. The goal of this K23 award is to evaluate how primary care providers at one large academic health system use a widely available price transparency tool and how price transparency at the point-of-prescribing affects clinical outcomes for middle-aged and older patients with multimorbidity. This health system’s price transparency tool, adopted in 2019, is compatible with all Medicare plans and ~95% of private insurance plans in its state. In Aims 1 and 2, Dr. Sloan will describe the uptake and acceptability of the price transparency tool using an ex- planatory sequential mixed methods design. In Aim 1, she will conduct an EHR-based retrospective cohort study of ~700 clinicians and ~140,000 patients aged >50 with multimorbidity to determine the clinician and patient factors associated with use. In Aim 2, she will conduct ~24 semi-structured interviews to explore reasons for use / non-use that may not be readily available in EHR data. Interviews will also assess the tool’s acceptability and feasibility for use among patients with multimorbidity. In Aim 3, she will conduct an EHR- and claims-based longitudinal retrospective cohort study to evaluate how use of the tool affects adherence and diabetes control in a subgroup of ~29,000 patients aged >50 with diabetes and multimorbidity. Throughout the award, Dr. Sloan will pursue training in geriatric and multimorbidity research, medical deci- sion-making, mixed methods, and program evaluation methods. Results from this award will directly inform the development of a multisite evaluation of price transparency tool implementation at institutions with different ge- ographies, patient populations, and practice patterns. The rigorous training and mentorship provided by this award, as well as Duke University’s superb research environment, will prepare Dr. Sloan well for a career dedi- cated to improving access to affordable care for middle-aged and older adults with multimorbidity.