Electronic medical records steered physicians to prescribe more generics

By John Murphy, MDLinx
Published May 27, 2016

Key Takeaways

A simple change in the default option of an electronic medical records (EMR) system immediately increased the percentage of generic prescriptions from 75% to 98%, according to researchers at the Perelman School of Medicine at the University of Pennsylvania, in Philadelphia, PA.

The study is one of a group of articles, published in the May 2016 issue of JAMA Internal Medicine, that characterize physicians’ attitudes and practices about the significant role of generic medications in health care.

For this study, researchers examined what resulted when the University of Pennsylvania Health System implemented a small change to its EMR system—the prescription screen defaulted to a generic equivalent medication. Physicians could still prescribe the brand name drug, but they had to select the “dispense as written” checkbox. This change was implemented among all specialties across the entire health system.

The researchers tracked oral drug prescriptions for 10 common medical conditions. Results showed that before the EMR change, physicians prescribed generic drugs 75% of the time. But they prescribed generics more than 98% of the time after the EMR change.

“Our results demonstrate that default options are a powerful tool for influencing physician behaviors but that they have to be well-designed to achieve the intended goals,” said lead author Mitesh S. Patel, MD, MBA, Assistant Professor of Medicine and Health Care Management in Penn’s Perelman School of Medicine and The Wharton School.

One exception to the generic trend was when physicians prescribed Synthroid for patients with thyroid conditions. The brand name drug is known to have different hormone levels than its generic version, levothyroxine. For this Rx, physicians opted out and selected the brand name 22% of the time.

“If a simple, low-cost change like adding an opt-out check box to prescription settings can make such a significant impact, there are likely other refinements that can be made just as easily that will also result in cost savings for patients and health systems,” said co-author C. William Hanson, MD, Chief Medical Information Officer at Penn Medicine. "It’s a valuable area of research to continue exploring.”

A valuable area of research

Other articles in the same issue of JAMA Internal Medicine took a similar view. An editorial pointed out that generic drugs account for 88% of all prescriptions filled in U.S. pharmacies, and generics have saved nearly $1.7 trillion in health care dollars in the past decade.

“Physicians and other prescribers should understand, for example, that patients are more likely to take a generic medication that they can afford compared with a ‘me-too’ medication that offers no additional benefit,” wrote authors Joshua M. Sharfstein, MD, of the Johns Hopkins Bloomberg School of Public Health, and Jeremy Greene, MD, PhD, of Johns Hopkins University School of Medicine in Baltimore, MD.

A separate investigation reported that the U.S. spent an extra $73 billion between 2010 and 2012 on brand name medications over the cost of generics. Of this amount, nearly $25 billion was out-of-pocket costs paid by patients, researchers reported. The drug classes that accounted for the largest amounts of excess costs included proton pump inhibitors, statins, atypical antipsychotics, and selective serotonin reuptake inhibitors.

The researchers advised that an effective way to drive down those costs is through therapeutic substitution—the practice of substituting a brand name drug with a different generic drug of the same therapeutic class. However, therapeutic substitution is hotly debated, and is opposed by most physician organizations as an attack on physician autonomy, the researchers noted.

“Although therapeutic substitution is controversial, it offers a potential mechanism to decrease drug costs if it can be implemented in a way that does not negatively affect quality of care,” the authors concluded.

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