E-prescribing influences doctors to order lower-cost drugs

Physicians say they consider prices more when presented with formulary information at the point of prescribing.

By — Posted April 1, 2013

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A study prepared for the pharmaceutical industry determined that a reduction in drug spending might not be only about more name brands getting generic competition — it also might be about electronic prescribing systems telling physicians that cheaper alternatives are available.

More than 60% of physicians with e-prescribing systems said their programs give them access to their patients' drug formulary data. Of those doctors, 75% said they pay more attention to patient costs when they prescribe, according to Decision Resources, a health care consulting firm in Burlington, Mass.

Many e-prescribing systems will alert a physician to the availability of a generic form of a drug they want to prescribe. Some physicians use the information to help make the best decisions, while others use the data as talking points to discuss care plans with patients, said Roy Moore, product manager for Decision Resources' U.S. Physician and Payer Forum and author of the study, released in March.

Although the survey included only 70 primary care physicians, 70 endocrinologists and 25 health plan pharmacy directors, they were enough for Moore to describe the increased adoption of health IT as a “notable threat” to the drug industry. But, he acknowledged, the results show advantages to patients who will benefit financially from lower-priced drugs.

Decision Resources' study came soon before research firm IMS Health reported that money spent on prescription drugs fell in 2012, the first year-over-year decline since the firm started tracking pharmaceutical spending in 1957. The decline was 1%, to $325.7 billion. The IMS Health report did not look at the impact of technology on prescribing patterns but cited the expansion of generic drug use. IMS said generics represented a record 84% of prescriptions in 2012, and it expects that total to peak in the next few years at close to 87%. Generic drugs can cost anywhere from 30% to 80% less than brand-name drugs, according to the Food and Drug Administration.

Jason Mitchell, MD, director of the American Academy of Family Physicians' Center for Health IT, thinks increased use of e-prescribing and electronic health records — both needed to earn incentives under the federal meaningful use initiative — show potential benefits for patients and physicians, and not just because of access to cost. Having drug information at hand to discuss with patients leads to better compliance and outcomes, he said.

“The real benefit from electronic prescribing is the two-way, bidirectional interaction” between the physician and patient, Dr. Mitchell said. “You need that bidirectional interaction so that when we write the script, or consider writing the script, we can get feedback through the e-prescribing system so that we can work with the patient and find the best option for them.” After receiving the information, a patient might decide to pay for a brand-name drug, Dr. Mitchell said.

Emphasis on effectiveness

Decision Resources said there are two strategies pharmaceutical companies must consider so they aren't left behind by doctors looking for less expensive care for their patients.

One is to ensure that their drugs get on health plans' “preferred” formulary, a category of brand-name drug that requires a lower co-pay than one not on that list. Getting the right spot on formularies is especially critical, the Decision Resources report said, because they're being sent to doctors in a timely fashion. Decision Resources said 80% of the plan pharmacy directors surveyed said they update their lists to physician e-prescribing systems at least once every quarter.

The other strategy Decision Resources recommended to drug companies was that they find ways to deliver data on drug efficacy to doctors' e-prescribing systems. The idea is that when doctors consider prescribing for certain illnesses, they will see not only formulary information but also company-generated reports on how well a drug works compared with others. In effect, this moves information often presented by a detailer in personal meetings with doctors into the e-prescribing system right at the point of writing a script.

Decision Resources reported that only 20% of endocrinologists and 28% of primary care physicians use their EHRs to track drug effectiveness in their patients. The report said “notable percentages” of doctors expressed a willingness to prescribe what they found to be more effective drugs even if they were more expensive.

Dr. Mitchell agrees that physicians should have access to clinical comparative data at the point of prescribing. But he said drug companies don't need to be involved in the creation or maintenance of clinical support tools and rules.

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External links

“Focus Groups Highlight That Many Patients Object To Clinicians Focusing On Costs,” Health Affairs, February (link)

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