Prescription Choices in EHRs Impact Care Costs

PHILADELPHIA — Researchers have found that programming electronic health records to make generic drugs a default choice when writing prescriptions may help to curb health care costs.

Authors from the Perelman School of Medicine, the Wharton School and the Center for Health Incentives and Behavioral Economics (CHIBE), which are all part of the University of Pennsylvania in Philadelphia, have published a study that is being published in the current issue of Annals of Internal Medicine. The issue is a special look at the research being done about innovative health care incentives.

“Prescribing brand-name medications that have a generic equivalent is a prime example of unnecessary health care spending because in most cases, generic medications are less expensive, similar in quality and may actually lead to better outcomes than brand names because of higher rates of patient adherence to generics,” said Mitesh S. Patel, MD, MBA, MS, assistant professor of medicine and health care management at Penn and lead study author, in a statement. “The results of this study demonstrate that leveraging default options can be a very effective way to change behavior.”
The study included four ambulatory clinics (two internal medicine and two family medicine) in the University of Pennsylvania Health System between June 2011 and September 2012. Researchers evaluated the difference in prescribing behavior for three commonly prescribed classes of medications — beta-blockers, statins and proton-pump inhibitors — between family medicine and internal medicine physicians.
The study analyzed almost 9,000 prescriptions in the pre-intervention period, the time when a person’s specific health problem is not known, and a total of 12,443 prescriptions during the intervention period, a time when the prescription would be used to improve a particular health problem. During the intervention phase of the study, the family medicine physicians continued to be shown both brand name and generic medication options within the EHR medication prescriber portal, but internal medicine physicians were shown a different display of only the generic medication options, with the ability to opt out. When compared to family medicine physicians that did not receive the intervention, internal medicine physicians had a significant increase in generic prescribing rates.
“Not only was changing the default options within the EHR medication prescriber effective at increasing generic medication prescribing, this simple intervention was cost-free and required no additional effort on the part of the physician,” Patel said in a statement. “The lessons from this study can be applied to other clinical decision efforts to reduce unnecessary health care spending and improve value for patients.”
A 2013 report from the Generic Pharmaceutical Association, which wasn’t part of the authors’ report, showed that over a 10-year period (2003 to 2012), generic drug use has generated more than $1.2 trillion in savings to the health care system.