Availability of Real-Time Prescription Benefit Information Among U.S. Hospitals

Real-time prescription benefit (RTPB) information provides patient-specific prescription benefit, formulary, and cost information within the electronic health record (EHR) at the point of prescribing. Examining the uptake of RTPB information by hospitals is critical because this data has the potential to reduce health care costs and provide patients with information at the point of care to make informed decisions.

As required by section 119(b)(3) of the Consolidated Appropriations Act of 2021, ONC recently adopted an RTPB certification criterion as part of the ONC Health IT Certification Program to establish a standardized approach for exchanging this information. Previous work has documented RTPB information availability among U.S. hospitals. (1,2) This data brief builds on that work by providing a national baseline of RTPB information availability in 2025, before RTPB certification becomes a required part of the Base EHR definition in 2028.

Highlights

• In 2025, 55% of U.S. hospitals reported RTPB information availability across all or almost all payers, while 20% reported availability for a limited set of payers and 25% reported no or unknown availability.
• RTPB information availability across all or almost all payers was lower among smaller, rural, critical access, and independent hospitals.
• Hospitals using the market-leading EHR developer were substantially more likely to report RTPB information availability across all or almost all payers than hospitals using other large or smaller EHR developers.
• RTPB information availability across all or almost all payers was higher among fully interoperable hospitals than among hospitals that were not fully interoperable (69% vs. 42%).

Over half of U.S. hospitals reported RTPB information availability across all or almost all payers in 2025.

Findings

• More than half (55%) of hospitals reported RTPB information availability across all or almost all payers.
• One in five hospitals (20%) reported RTPB information availability for a limited set of payers.
• One in four hospitals (25%) reported either no RTPB information availability (12%) or did not know whether their EHR supported RTBP functionality (13%).

Figure 1: Percent of hospitals reporting real-time prescription benefit information availability from payers

Source: 2025 American Hospital Association (AHA) Information Technology (IT) Survey.
Notes: See Methods and Definitions for further details on the calculation of these metrics and terminology. All percentages are weighted.

RTPB information availability varied across hospital characteristics, value-based care participation, and EHR developer.

Findings

• RTPB information availability across all or almost all payers increased with hospital size: 48% of small, 62% of medium, and 69% of large hospitals had RTPB information available.
• Availability was lower among independent vs. system-affiliated hospitals (40% vs. 62%), rural vs. urban hospitals (46% vs. 62%), and critical access vs. non-critical access hospitals (46% vs. 60%).
• Availability was also higher among hospitals participating in an ACO (62% vs. 46%) and those with quality-linked payment arrangements compared to their counterparts (62% vs. 47%).
• RTPB information availability varied substantially by EHR developer. Hospitals using the market-leading EHR developer were most likely to report availability across all or almost all payers (66%), compared with 51% of hospitals using other market leading developers and 21% using all other EHR developers. More than half of hospitals using other EHR developers reported no or unknown RTPB availability (57%).

Table 1: RTPB information availability by hospital characteristics, value-based care participation, and EHR developer, 2025.

Hospital Characteristics	All/Almost All Payers	Some Payers	No/Unknown Payers
Overall RTPB Availability	55%	20%	25%
Hospital Size
Small (53%) (ref)	48%	20%	32%
Medium (36%)	62%*	18%	20%*
Large (11%)	69%*	22%	9%*
Location
Rural (40%)	46%	21%	34%
Urban (60%)	62%*	19%	19%*
Critical Access
CAH (31%)	46%	21%	33%
Non-CAH (69%)	60%*	19%	21%*
System Affiliation
Independent (32%)	40%	24%	37%
System Affiliated (68%)	62%*	18%*	20%*
ACO Participation
Not Current (36%)	46%	23%	31%
Current (64%)	62%*	21%	16%*
Quality-Linked Payment
No (38%)	47%	21%	32%
Yes (62%)	62%*	22%	16%*
Ownership
For-profit (13%) (ref)	53%	8%	39%
Non-profit (66%)	58%	22%*	20%*
Government (21%)	50%*	19%*	31%*
EHR Developer
Market Leader (52%) (ref)	66%	22%	12%
Other Large Developers (35%)	51%*	16%*	33%*
Smaller Developers (13%)	21%*	22%	57%*

RTPB information availability was higher among fully interoperable hospitals.

Findings

• Among fully interoperable hospitals, 69% reported RTPB information availability across all or almost all payers, compared with 42% of hospitals that were not fully interoperable.
• RTPB information availability across all or almost all payers was 27 percentage points higher among fully interoperable hospitals than among hospitals that were not fully interoperable.

Figure 2: RTPB information availability across all or almost all payers, by hospital interoperability status, 2025.

Source: 2025 American Hospital Association (AHA) Information Technology (IT) Survey.
Notes: See Methods and Definitions for further details on the calculation of these metrics and terminology. All percentages are weighted. * Significantly different from reference category (p<0.05).

Hospitals with broader RTPB information availability reported higher routine availability and use of outside clinical information.

Findings

• Hospitals reporting RTPB information availability across all or almost all payers had the highest levels of both routine availability (79%) and frequent use (71%) of outside clinical information, compared with 35% and 32%, respectively, among hospitals reporting no or unknown RTPB information availability.

Figure 3: Routine availability and frequent use of outside clinical information reported by hospitals, by RTPB information availability across payers, 2025.

Source: 2025 American Hospital Association (AHA) Information Technology (IT) Survey.
Notes: See Methods and Definitions for further details on the calculation of these metrics and terminology. All percentages are weighted.  

Summary

This brief examines RTPB information availability among non-federal acute care hospitals in the U.S., how availability varies across hospitals, and how it relates to broader measures of electronic health information availability and use. More than half (55%) of hospitals reported RTPB information availability across all or almost all payers, while 20% reported availability across a limited set of payers and about one-quarter reported no or unknown availability. These findings indicate that broad RTPB information availability is already reported by a majority of hospitals, but gaps remain before the 2028 certification requirements take effect.

RTPB information availability across all or almost all payers was generally higher among larger, system-affiliated, urban, and non-critical access hospitals. RTPB information availability was also more common among hospitals participating in ACOs and those with quality-linked payment arrangements. These patterns may reflect differences in the organizational and technical resources available to support RTPB functionality, as well as broader health IT capabilities among hospitals participating in value-based care arrangements. RTPB information availability also varied by EHR developer. Hospitals using the market-leading EHR developer reported broader RTPB information availability than those using other large or smaller EHR developers. These findings may reflect differences in health IT capabilities and resources of the hospitals served by these developers. Finally, RTPB information availability varied by hospitals’ interoperability status, defined by their ability to routinely obtain and integrate patient health information from outside sources: 69% of fully interoperable hospitals reported availability across all or almost all payers, compared with 42% of hospitals that were not fully interoperable.

Given prior evidence that fully interoperable hospitals are more likely to report routine availability and frequent use of patient health information from outside sources (3), the higher levels of these measures observed among hospitals reporting RTPB information availability across all or almost all payers are consistent with broad patterns of interoperability. This relationship may reflect the broader technical and organizational capabilities needed to integrate information from external sources into clinical workflows. These capabilities may facilitate the exchange and integration of patient-specific prescription information from health plans. Nearly four in five (79%) of hospitals that report RTPB information availability across all or almost all payers routinely had outside clinical information available at the point of care, and 71% frequently used this information. In comparison, among hospitals reporting no or unknown RTPB information availability, 35% routinely had outside clinical information available and 33% frequently used it, further suggesting that broader interoperability capabilities may provide an important foundation for supporting RTPB functionality.

RTPB information provides prescribers with patient-specific information on medication costs, coverage requirements, and lower-cost alternatives. Prior studies have found higher prescription fill rates and lower patient copay costs when prescribers selected lower-cost alternatives identified through RTPB (4). Prior research also suggests that clinicians see potential for RTPB information to support medication cost discussions, but incomplete information, inaccurate cost estimates, clinically inappropriate alternatives, and limited training may hinder use (5).

Since 2021, Medicare Part D plan sponsors have been required to adopt one or more tools capable of providing prescribers with patient-specific drug pricing and benefit information at the point of prescribing (6). More recently, The Health Data, Technology, and Interoperability: Electronic Prescribing, Real-Time Prescription Benefit and Electronic Prior Authorization (HTI-4) final rule established a new RTPB certification criterion based on the National Council for Prescription Drug Programs (NCPDP) Real-Time Prescription Benefit standard version 13 (7). Beginning January 1, 2028, this criterion will be required for compliance to meet the Base EHR definition, and Health IT Modules presented for certification to the electronic prescribing criterion must also be certified to the RTPB criterion (8).

These findings provide a national baseline of the availability of RTPB information in hospital settings ahead of the 2028 RTPB certification requirements. Because this analysis was conducted before the Base EHR definition’s compliance date for the RTPB certification criterion under the Health IT Certification Program, these data do not indicate whether hospitals’ RTPB information was provided using the standards adopted in HTI-4 or otherwise met the RTPB certification criterion. However, these data do provide insight into hospitals’ capabilities to support these upcoming requirements. Continued measurement can help assess changes as the certification requirements are implemented and identify whether gaps in availability persist.

Definitions

ACO Participation: Hospitals reporting that they currently lead or participate in an accountable care organization (ACO). Hospitals that formerly participated or had never participated were classified as not currently participating.

Electronic health record (EHR): A digital version of a patient’s paper chart. It contains health information collected and maintained by healthcare providers over time. It’s a comprehensive, longitudinal record of a patient’s health history, including diagnoses, lab results, medications, physician notes, and more, accessible to authorized healthcare professionals.

Critical Access Hospital: Hospitals with less than 25 beds and at least 35 miles away from another general or critical access hospital.

Fully Interoperable: Non-federal acute care hospitals that reported routinely or sometimes finding, sending, and receiving electronic health information and integrating electronic patient health information received from sources outside their hospital or hospital system.

Some Payers: Hospitals that reported RTPB information availability for prescriptions covered by a limited set of payers.

Large hospital: Non-federal acute care hospitals of bed sizes of 400 or more.

Medium hospital: Non-federal acute care hospitals of bed sizes of 100-399.

All or almost all payers: RTPB information available for prescriptions covered by all or nearly all the payers with which the hospital interacts.

No/unknown RTPB information availability: Hospitals that reported no RTBT functionality or did not know whether their EHR presented real-time prescription benefit information.

Non-federal acute care hospital: Hospitals that meet the following criteria: acute care general medical and surgical, children’s general, and cancer hospitals owned by private/not-for-profit, investor-owned/for-profit, or state/local government and located within the 50 states and District of Columbia.

Real-Time Prescription Benefits (RTPB): A standardized approach to exchanging patient-specific prescription benefit information at the point of prescribing using an industry-standard electronic transaction. The RTPB certification criterion adopted in HTI-4 is based on NCPDP Real-Time Prescription Benefit standard version 13.

Real-Time Prescription Benefits Information: Patient-specific prescription benefit, formulary, and cost information available within the EHR at the point of prescribing.

Rural hospital: Hospitals located in a non-metropolitan core-based statistical area.

Small hospital: Non-federal acute care hospitals with fewer than 100 beds.

System-affiliated hospital: A system is defined as either a multi-hospital or a diversified single hospital system. A multi-hospital system is two or more hospitals owned, leased, sponsored, or contract managed by a central organization. Single, freestanding hospitals may be categorized as a system by bringing into membership three or more, and at least 25 percent, of their owned or leased non-hospital pre-acute or post-acute health care organizations.

Quality-linked payment: Hospitals that reported commercial payer contracts in which payment was tied to performance on quality or safety measures.

Data Sources and Methods

Data are from the American Hospital Association (AHA) Information Technology (IT) Survey. Since 2008, ONC has partnered with the AHA to measure the adoption and use of health IT in U.S. hospitals. ONC funded the AHA IT Supplement to track hospital adoption and use of EHRs and the exchange of clinical data. 

The chief executive officer of each U.S. hospital was invited to participate in the survey regardless of AHA membership status. The person most knowledgeable about the hospital’s health IT (typically the chief information officer) was requested to provide the information via a mail survey or secure online site. Non-respondents received follow-up mailings and phone calls to encourage response.

The 2025 survey was fielded from April to October 2025. The response rate for non-federal acute care hospitals was (N = 2,351) 55%. A logistic regression model was used to predict the propensity of survey response as a function of hospital characteristics, including size, ownership, teaching status, system membership, and availability of a cardiac intensive care unit, urban status, and region. Hospital-level weights were derived by the inverse of the predicted propensity. For analyses by EHR developer, hospitals were grouped into three categories reflecting EHR developer market presence. Hospitals using Epic were categorized as using the market-leading EHR developer; hospitals using Oracle Health (Cerner) or MEDITECH were categorized as using other large EHR developers; and hospitals using all other EHR developers were categorized as using smaller EHR developers. Because this analysis was conducted using 2025 survey data collected before RTPB certification becomes part of the Base EHR definition in 2028, reported RTPB information availability may reflect a variety of existing implementations. Therefore, these data measure access to real-time prescription benefit information rather than adoption of certified RTPB functionality.

Data Availability

American Hospital Association (AHA) Information Technology Supplement data are available for purchase from the AHA: https://www.ahadata.com/aha-healthcare-it-database. If you have questions or would like to learn more about the data source or these findings, you may contact ONC_Data@hhs.gov.

References

1. Office of the National Coordinator for Health Information Technology. “Hospital Adoption of Real-Time Benefit Tools,’ Health IT Quick Stat #67.
2. Klebanoff MJ, Li P, Chatterjee P, Doshi AJ. Real-Time Prescription Benefit Tool Adoption Among US Hospitals. JAMA Health Forum. 2024;5(10):e243181
3. Gabriel MH, Richwine C, Strawley C, Barker W, Everson J. Interoperable Exchange of Patient Health Information Among U.S. Hospitals, 2023. Office of the National Coordinator for Health Information Technology: Washington DC. Data Brief: 71. 2024.
4. Fitts A, Teare AJ, Nelson SD. American Journal of Health-System Pharmacy. 2024. 81(19):e620-e626
5. Sloan CE, Levinson D, Senatus W, Ubel PA, Davis JK, Macke L, Sweeney R, Sinaiko AD, Goss FR, King HA, Wang V. The Promises and the Pitfalls of Real-time Benefit Tools: A Qualitative Study of Primary Care Providers. JGIM. 2026; 1-9.
6. Centers for Medicare & Medicaid Services. 2019. Medicare Advantage and Part D Drug Pricing Final Rule (CMS-4180-F). Available at: https://www.cms.gov/newsroom/fact-sheets/medicare-advantage-and-part-d-drug-pricing-final-rule-cms-4180-f
7. Office of the National Coordinator for Health Information Technology. 2025. HTI-4 Overview and Key Dates for Certification Program. Available at: https://healthit.gov/resources/hti-4-overview-and-key-dates-for-certification-program/
8. Office of the National Coordinator for Health Information Technology. 2025. HTI-4 Final Rule: Overview Fact Sheet. Available at: https://healthit.gov/resources/hti-4-final-rule-electronic-prescribing-real-time-prescription-benefit-and-electronic-prior-authorization/

Acknowledgments

The authors are with the Office of Standards, Certification, and Analysis, within the Office of the National Coordinator for Health IT (ONC). The data brief was drafted under the direction of Mera Choi, Director of the Technical Strategy and Analysis Division, Vaishali Patel, Deputy Director of the Technical Strategy and Analysis Division, and Wesley Barker, Chief of the Data Analysis Branch.

Suggested Citation

Gabriel MH and Blase A. Availability of Real-Time Prescription Benefit Information Among U.S. Hospitals. Office of the National Coordinator for Health Information Technology. Data Brief: 87. September 2026.