Last week, Epic Systems – a leading electronic health record (EHR) vendor – announced a new software feature that will allow clinicians and their patients to compare prescription drug pricing across pharmacies, including cash prices outside the patient’s benefit. The feature, Prescription Marketplace, builds on existing Real-Time Prescription Benefit (RTPB) tools that display each patient’s expected out-of-pocket (OOP) costs and coverage requirements for medications available through insurance. While this and other RTPB tools could make it easier for patients to find lower-cost medications, a familiar question remains: Will greater price transparency alone meaningfully reduce prescription drug costs and improve usage, or merely change how patients purchase their medications?

Even with today’s largely digital prescribing workflows, clinicians and their patients often learn about actual copayments or coinsurance amounts only after a pharmacy processes the prescription. RTPB tools aim to address this problem by communicating patient-specific cost estimates and coverage information before a clinician submits the prescription order. Embedded directly within an EHR, these tools query insurers or their intermediaries in real time to identify expected OOP costs, lower-cost drug alternatives, and any coverage requirements (such as prior authorization). Armed with this pricing and coverage information, clinicians could then discuss options with patients and potentially adjust treatment before patients encounter unexpected issues at the pharmacy counter.

RTPB tools are increasingly being deployed in clinicians’ offices. Surescripts – the nation’s electronic prescribing network by transaction volume – reported that more than 900,000 prescribers used its RTPB module in 2025, generating over one billion queries. Widespread use, however, does not necessarily mean clinicians heed pricing alerts or that patients realize lower costs. A recent study of roughly 5,000 clinicians working in a health system with integrated RTPB tools found that clinicians modified prescription drug orders in response to just 11 percent of total alerts and only rarely accepted the alternative options suggested by the tool. Additionally, a 2025 study examining more than 2.8 million Medicare Advantage beneficiaries found no statistically significant reductions in patient OOP spending or total prescription drug spending during the first year following implementation of an RTPB tool.

Epic’s planned expansion of RTPB integrations would introduce cash-price information to medication pricing comparisons beginning next year. Through Nebula, its cloud computing platform, Epic will gather cash-price information from participating pharmacies and display those offerings directly within the prescribing clinician’s EHR terminal. This allows clinicians to compare cash offers with the estimated OOP costs for the drugs covered under the patient’s insurance. Prescription Marketplace will also display pharmacy membership programs and delivery options, with several online pharmacies and direct-to-consumer prescription drug platforms already announced as Epic partners. Rather than replacing existing RTPB integrations on Epic platforms, the new feature will bring additional purchasing options into the same prescribing workflow, widening the scope of medication offerings visible to clinicians and their patients.

For patients, the value proposition seems straightforward. Depending on the medication, insurance benefit, and pharmacy, paying in cash may be less expensive or more convenient than purchasing through insurance. This is particularly true for patients facing high deductibles, substantial cost-sharing, or strict coverage requirements. In some instances, finding cash options during prescribing may help assuage patients’ concerns about affordability and prevent delays or abandonment of treatment. Nevertheless, the lowest price for a prescription may not be the least expensive option over time. Purchases of prescription drugs made outside insurance generally do not count toward a patient’s deductible or OOP limit. This means patients could save money on individual prescriptions while also delaying access to more generous coverage later in the year, depending on how their medication needs and spending change.

This tradeoff also raises questions about the role clinicians will play in helping patients navigate medication purchasing options. Prescription Marketplace or similar tools would make it easier for clinicians to identify lower-cost alternatives without searching across multiple platforms, but determining which option offers the best value for the patients is more complicated. Should clinicians consider each patient’s deductible, pharmacy preferences, and anticipated medication expenses when helping patients weigh immediate savings against potential future costs? These considerations go beyond traditional prescribing workflows, and clinicians may need to reallocate limited time during patient visits. As the existing RTPB research suggests, making prescription drug pricing information more readily available does not necessarily mean that information will change prescribing decisions.

Despite these uncertainties about its use in real scenarios, Prescription Marketplace represents a meaningful effort to make prescription drug prices more transparent and accessible to clinicians and their patients at the point of prescribing. Its success, however, should not only be measured by the number of patients that choose cash-pay options over insurance, but also by whether those choices ultimately lead to lower OOP and improved medication adherence over the long term. For policymakers, the new feature also highlights a crucial distinction between helping patients find lower prices and reducing the underlying cost of prescription drugs. While initiatives that improve price transparency may help patients identify more affordable purchasing options, they do not directly address the conditions affecting manufacturer prices, negotiated rebates, and other financial arrangements that more directly impact drug spending.