Sloan's K23: Using Price Transparency Tools to Improve Medication Adherence

Caroline Sloan, MD, assistant professor of medicine in the division of General Internal Medicine (GIM), was recently awarded a K23 career development award by the National Institute on Aging. Her project is entitled "Improving medication adherence and disease control for patients with multimorbidity: the role of price transparency tools." Sloan is a general internist and health services researcher whose long-term career goal is to evaluate the effectiveness of policies and interventions that address barriers to care for older adults with multimorbidity.

Numerous patients with multimorbidity struggle to pay for their medications. Because of this, these patients have lower medication adherence, resulting in a higher risk of disease progression, functional limitations, hospitalization, and death. Often times patients don't know the cost of their prescriptions until they get to the pharmacy,  making it difficult for them to account for medication costs in their medical decisions. If clinicians could access information about their patients’ medication-related out-of-pocket costs at the point-of-prescribing, they could help their patients apply for financial support, or prescribe lower-cost alternatives.

"I’m really excited for this grant to start and am so grateful for all the support I’ve received so far to develop it, especially from my mentors, Drs. Peter Ubel, Virginia Wang, Matt Maciejewski, and Barrett Bowling," says Sloan. 

Caroline Sloan
Caroline Sloan, MD

The goal of this K23 award is to evaluate how primary care providers at one large academic health system use a widely available price transparency tool and how price transparency at the point of prescribing affects clinical outcomes for middle-aged and older patients with multimorbidity.

The Study Aims

  • Aim 1: conduct an EHR-based retrospective cohort study of ~700 clinicians and ~140,000 patients aged >50 with multimorbidity to determine the clinician and patient factors associated with use.
  • Aim 2: conduct ~24 semi-structured interviews to explore reasons for use/non-use that may not be readily available in EHR data. Interviews will also assess the tool’s acceptability and feasibility for use among patients with multimorbidity.
  • Aim 3: conduct an EHR- and claims-based longitudinal retrospective cohort study to evaluate how the use of the tool affects adherence and diabetes control in a subgroup of ~29,000 patients aged >50 with diabetes and multimorbidity.

"My goal is for this K23 grant to help me become an expert in developing, evaluating, and advocating for federal and state policies that reduce financial barriers to care, especially for adults who have multiple chronic conditions and complex treatment plans," Sloan says. 

Throughout the award, Dr. Sloan will pursue training in geriatric and multimorbidity research, medical decision-making, mixed methods, and program evaluation methods. Results from this award will directly inform the development of a multisite evaluation of price transparency tool implementation at institutions with different geographies, patient populations, and practice patterns. The rigorous training and mentorship provided by this award will prepare Dr. Sloan well for a career dedicated to improving access to affordable care for middle-aged and older adults with multimorbidity.