New Prescription Benefits Rule Could Reduce Costs for Patients
Dr. Thomas Keene, the National Coordinator for Health IT at the Department of Health and Human Services (HHS), shared insights with Breitbart News about a new rule from the Trump administration aimed at improving prescription accessibility. He mentioned that this Real-Time Prescription Benefits Technology could potentially save patients hundreds of dollars a month and might even prevent numerous deaths linked to unaffordable medication.
Medical expenses consistently rank among the top financial worries for many Americans. It’s surprising, or maybe not, that nearly half of adults report struggling with medical bills, and a significant 43% have refrained from filling prescriptions in the past year due to costs. It’s concerning, to say the least.
Prices for medications can fluctuate dramatically, depending on various factors like health insurance coverage, pharmacy plans, and individual patient circumstances. Out-of-pocket spending on medications hit $98 billion in 2024, marking a 25% increase from 2019. Patients often find themselves blindsided by high prices at the pharmacy, leading to unfilled prescriptions and worsening health issues—it’s a cycle that doesn’t bode well for anyone. It’s estimated that lacking necessary medications claims around 125,000 American lives annually, contributing to a healthcare cost burden around $300 billion every year.
In response to this pressing issue, the Trump administration has put forth a proposal aimed at alleviating these problems.
Dr. Keene explained that HHS will mandate all certified health IT platforms adopt the new real-time prescription benefit technology by the end of 2027. This means that physicians will have access to cost information for specific drugs and their alternatives right when they’re prescribing.
Keene emphasized the importance of ensuring that medical records allow prescribers to know how much a drug will cost a specific patient, as well as the costs of equivalent alternatives.
He remarked that if doctors are considering anti-inflammatory medications, this rule will empower them to select treatments that are both affordable and effective.
Interestingly, Keene noted that this technology is being adopted faster now. Insurers seem motivated to provide patients with the lowest-priced medications that fit their needs.
According to data analyzed, patients could see significant savings: around $42 monthly for standard prescriptions, about $135 for diabetes medications, and around $800 monthly for specialty drugs.
He elaborated that this reform aims to restore some market dynamics, allowing patients a clearer understanding of their healthcare costs. The comparison to shopping for cheaper products online was an interesting analogy he used. In many ways, healthcare hasn’t operated that way before, but the goal of the Trump administration was to initiate these changes.
Keene explained that the Republican administration is focused on making healthcare operate more like a market. And what does that entail? Well, it’s all about having prices available, ensuring good supply, and maintaining quality standards. Just as consumers can compare car prices easily, they should also be able to do the same for healthcare.
Moreover, he shared that HHS aims to help doctors identify instances where patients could save money by paying out-of-pocket rather than relying solely on insurance. He highlighted that some pharmacy benefit managers, like GoodRx, are actively working to lower drug prices, while options like TrumpRx are making affordable medications available.
One of the roadblocks to the implementation of this technology has been the medical industry’s tendency to profit from unclear pricing or from patients being unaware of potential savings. Thankfully, as more healthcare providers transition to electronic health records, the adoption of this technology is becoming more feasible.
