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A billion real-time benefit checks ran in 2025 across nearly a million prescribers. That is, by any reasonable measure, a structural shift in how prescribing decisions get made in the United States. Five years ago, cost visibility at the visit was a feature on a vendor's roadmap. Today, it's the default. The clinician sees the patient's expected cost on the screen, in the moment, before the prescription is signed. The clinical conversation that used to end at the medication choice now extends into the affordability context. Patients hear a number before they leave the room. Prescribers can adjust the therapy when the number is wrong for the patient in front of them. That's a real win — not a vendor narrative, an actual change in how the room operates. And then. The billion checks produced a billion price disclosures. They did not produce a billion completed therapy starts. A check is a number on a screen. What comes after the number — the program activation, the prior authorization, the enrollment, the fill — still requires a workflow. If that workflow doesn't exist on the same screen, the cost visibility ends as a clinical conversation rather than as a therapy start. The pattern that's emerging in the data is consistent. RTBC adoption is broad. Patient cost visibility is high. Patient cost resolution — the share of prescriptions where the visible cost actually produced a filled medication on the original prescribing intent — has not moved at the same rate. The first step of the chain got faster. The next three didn't. Visibility was step one. Resolution is the rest of the chain. The leverage now isn't more checks. It's connecting the check to the workflow that closes the rest of the decision — affordability program, PA, enrollment, fill — on the same record, in the same motion, inside the screen that already showed the number. Visibility was step one. #RTBC #PatientAccess #MedicationAccess #TherapyStart #PriorAuthorization #HealthcareData #CarePathways