E-prescribing system increases generic usage

Introducing electronic prescribing systems and coupling them to formulary decision support (FDS) systems allows clinicians to prescribe preferred medications more frequently, according to a study involving two large Massachusetts insurers.

Researchers at Brigham & Women’s Hospital found that those who used e-prescribing showed a 3.3 percent increase in prescribing tier 1 (generic) medications. The researchers also reported a corresponding decrease in the proportion of prescriptions from tiers 2 and 3 (brand names). For physicians who adopted e-prescribing systems, 20 percent of the prescriptions were electronic.

The researchers estimate that e-prescribing with FDS at this rate could save $845,000 per 100,000 patients.

The researchers tested the savings potential before and after an e-prescribing system was launched, calculating the proportion of prescriptions written in each of three formulary tiers. Tier 1 medications required the lowest copayments and were all generic medications.

“Among the physicians who used e-prescribing, we saw these changes in tier 1 generic prescribing. When they didn’t use e-prescribing, they stayed on the same trend line as everyone else,” says Michael Fischer, MD, MS, the lead author.

“Our results suggest that if an insurer can find a way to get doctors the formulary information in a way that doesn’t interfere with their workflow, and in a timely manner, even in a state where there is a lot of generic drug use, doctors will act on it,” says Fischer.

Physicians who wrote electronic prescriptions were slightly younger and more likely to be female than those who did not. In addition, internists, pediatricians, and family physicians made up nearly 75 percent of those who used e-prescribing. The study is published in the Dec. 8 issue of Archives of Internal Medicine.

The intervention group prescribed 1.4 percent more tier 1 medications, 0.3 percent fewer tier 2 medications, and 1 percent fewer tier 3 medications than the control group.

Source: Fischer MA, Vogeli C, Stedman M, et al. Effect of electronic prescribing with formulary decision support on medication use and cost. Arch Intern Med. 2008;168(22):2433–2439

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