Real-Time Benefit Tools (RTBT) Integration in EHR Systems

by석아산 • • 2 min read
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A four-panel digital comic titled “Real-Time Benefit Tools (RTBT) Integration in EHR Systems.” Panel 1: A woman says, “Patients are abandoning prescriptions..” and a man responds, “We need price data up front!” Panel 2: Another woman holds a laptop and says, “I’ve added real-time benefit tool access,” showing a screen labeled “EHR RTBT.” She adds, “This shows prices while prescribing.” Panel 3: The first woman replies, “Thank you.” and the man says, “Prior authorizations can even be bypassed! This will really help our workflow.” Panel 4: All three providers cheer, “Great! Let’s try it out!”

Real-Time Benefit Tools (RTBT) Integration in EHR Systems

Patients often abandon prescriptions due to unexpected costs or delays caused by prior authorizations.

Real-Time Benefit Tools (RTBT) solve this by giving clinicians instant access to patient-specific drug pricing and coverage details—directly within the EHR workflow.

This post explains how healthcare organizations can integrate RTBT into their EHR systems and improve outcomes, adherence, and satisfaction.

📌 Table of Contents

What Is a Real-Time Benefit Tool (RTBT)?

💊 An RTBT provides prescribers with real-time access to drug cost, coverage status, and preferred alternatives for a specific patient—while they're writing the prescription.

💊 It uses payer-specific formulary data, pharmacy benefit manager (PBM) APIs, and patient eligibility feeds.

💊 RTBT supports informed decisions, such as switching to a covered drug or bypassing prior authorization delays.

Why RTBT Belongs Inside the EHR

🏥 Embedding RTBT inside the EHR allows physicians to see:

✔️ Medication costs based on patient plan

✔️ Generic or formulary-compliant alternatives

✔️ Step therapy or prior auth alerts

✔️ Pharmacy network availability

This improves patient-provider conversations and medication adherence rates.

Technical Architecture and Integration Steps

🧩 Use standard APIs defined by NCPDP Real-Time Prescription Benefit (RTPB) standard

🧩 Connect with PBMs such as OptumRx, Express Scripts, CVS Caremark

🧩 Configure the EHR to display RTBT outputs in prescribing UI (Epic, Cerner, athenahealth, etc.)

🧩 Apply caching and fallback for real-time downtime scenarios

Compliance and Standards (CMS, NCPDP)

📜 CMS Final Rule (May 2021): Medicare Part D plans must support RTBT by prescribers’ systems

📜 RTBT specs must meet NCPDP RTPB standards for eligibility, coverage, and price transmission

📜 Ensure all data sharing follows HIPAA and ONC Information Blocking Final Rule guidelines

Patient and Financial Impact

💡 Decreased prescription abandonment by showing cheaper options in real time

💡 Fewer phone calls between prescribers, pharmacies, and PBMs

💡 Improved patient trust and satisfaction

💡 Higher medication adherence and better chronic disease control outcomes

Explore RTBT, Pharmacy API & EHR Add-Ons











Keywords: RTBT EHR integration, real-time prescription benefit, pharmacy benefit API, CMS RTBT compliance, drug pricing transparency

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