Price Transparency Is Not the Same as Affordability and Adherence

Real-time benefit tools (RTBTs) can provide clinicians with patient-specific information about out-of-pocket medication costs and potentially less costly alternatives, but an editorial in the Journal of General Internal Medicine cautions that price transparency should not be equated with affordability or medication adherence. The article argues that these tools may support cost discussions and reduce some administrative burdens, while recognizing that they do not address all the factors influencing medication use.

RTBTs are decision-support systems embedded in electronic health records. They display patient-specific medication costs and suggest less expensive alternatives at the point of care. Studies described in the editorial have reported mixed results: some found decreases in out-of-pocket costs and increases in medication fill rates, whereas others found no discernible differences in overall medication dispensing or spending. The editorial also identifies limitations, including missing pharmacy-benefit information for some patients, inaccurate cost estimates and insufficient recommendations about alternative treatments.

The editorial draws on a recent qualitative analysis by Sloan and colleagues, published in the same journal issue. The study interviewed 35 primary care clinicians about their experiences with RTBTs. It was an interview-based qualitative study rather than a trial measuring medication costs, prescribing or adherence. Its findings were organized around three themes: limited clinician education and substantial knowledge gaps alongside receptiveness to training; the perceived potential to improve patient care by facilitating cost discussions and reducing back-and-forth communication among clinics, insurers and pharmacies; and inaccurate or incomplete information that generated mistrust and could hinder broader adoption.

These findings describe clinicians’ reported experiences and perceptions, not measured improvements in clinical outcomes. The analysis also concerned RTBT use among the participating primary care clinicians, so it does not establish how the tools affect patients across the wider health system. In particular, the editorial’s conclusion that tools can be helpful and well intentioned is based partly on prior research and partly on the qualitative evidence summarized from the Sloan study.

Federal requirements may shape the future availability of RTBT data and integration. The editorial states that Medicare Part D sponsors must follow standards for transmitting cost and coverage data to RTBTs beginning in 2027, and that all electronic health records must incorporate RTBTs into their base products starting in 2028. The authors suggest that more accurate information and capabilities incorporating patient characteristics, clinical indications and drug-drug interactions could support treatment discussions. These are prospective implications, not outcomes demonstrated by the qualitative study.

Even if their information and functions improve, RTBTs cannot control the underlying prices of medications in the United States. The editorial attributes high prices partly to limited centralized negotiating power, absent cost controls and coverage requirements imposed by government-funded prescription drug benefit programs. It describes broader pricing strategies that include limiting market-exclusivity rights, ensuring timely generic availability, expanding opportunities for government payers to negotiate, conducting comparative cost-effectiveness research and educating patients and prescribers about drug pricing.

Affordability is also not equivalent to adherence. The editorial cites the World Health Organization’s description of five determinants of treatment adherence: socioeconomic, health-system, condition-related, therapy-related and patient-related factors. Medication cost is one socioeconomic determinant, alongside health literacy, family and social support, housing stability, insurance coverage, access to care facilities and pharmacies, and cultural beliefs about illness and healing. The authors therefore emphasize that understanding medication use requires attention to the factors affecting an individual patient rather than a focus on price information alone.

Attention is also needed to the setting in which tools appear. The editorial notes that numerous digital decision-support systems in electronic health records can contribute to clinicians disregarding information. RTBTs may consequently be viewed as another medication alert, potentially producing a “streetlight effect”: health systems may concentrate on readily measurable outcomes such as out-of-pocket costs while underinvesting in more difficult-to-quantify issues, including the complexity of medication regimens and patients’ understanding of each medicine’s purpose. The article presents this as a risk rather than as a demonstrated effect of RTBT implementation.

Overall, the editorial presents RTBTs as promising when thoughtfully integrated but warns against treating visible price information as a substitute for action on medication prices, affordability and the multiple determinants of adherence. It calls for research that continues to examine facilitators and barriers to use, alongside honest clinical discussions of patients’ beliefs, fears, goals and financial circumstances. The evidence summarized in the article supports the view that RTBTs can inform care, but it does not show that they alone can resolve the underlying causes of non-adherence or make prescribed medicines affordable.

Subject of Research: Editorial analysis of real-time benefit tools, medication affordability and treatment adherence

Article Title: Price Transparency Is Not the Same as Affordability and Adherence

Article References: Hwang, C. S., & Steinman, M. A. (2026). Price Transparency Is Not the Same as Affordability and Adherence. Journal of General Internal Medicine. https://doi.org/10.1007/s11606-026-10886-6

Image Credits: AI Generated

DOI: 10.1007/s11606-026-10886-6

Keywords: real-time benefit tools, medication prices, out-of-pocket costs, treatment adherence, health literacy, electronic health records, patient care, primary care clinicians, qualitative research, health policy, Price, Transparency