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

 

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.

πŸ“Œ Table of Contents

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

πŸ’Š 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.

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

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

Why RTBT Belongs Inside the EHR

πŸ₯ 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)

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

πŸ“œ RTBT specs must meet NCPDP RTPB standards for eligibility, coverage, and price transmission

πŸ“œ Ensure all data sharing follows HIPAA and ONC Information Blocking Final Rule guidelines

Patient and Financial Impact

πŸ’‘ Decreased prescription abandonment by showing cheaper options in real time

πŸ’‘ Fewer phone calls between prescribers, pharmacies, and PBMs

πŸ’‘ Improved patient trust and satisfaction

πŸ’‘ 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