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Making Generics “Default” on EHR Increases Prescriptions Over Brand Names

PHILADELPHIA – Group practices that want physicians to be more sensitive to patients’ cost concerns by prescribing generic drugs whenever possible may have an easy way to make that happen.

A new study, published in a special issue of the Annals of Internal Medicine, suggests that programming electronic health records (EHR) to make generic drugs the default choice can influence physician prescription choices. Researchers were from the Perelman School of Medicine, The Wharton School and the Center for Health Incentives and Behavioral Economics, all at the University of Pennsylvania and the Philadelphia VA Medical Center.

"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 lead author Mitesh S. Patel, MD, MBA, MS. “The results of this study demonstrate that leveraging default options can be very effective way to change behavior."

Involved in the study between June 2011 and September 2012 were four ambulatory clinics -- two internal medicine and two family medicine -- in the University of Pennsylvania Health System. 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. More than 20,000 prescriptions were reviewed.

During the intervention phase of the study, family medicine physicians were 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.

During the pre-intervention period, family medicine providers had slightly higher rates of generic medication prescribing but both groups had similar trends, according to the study.

In the post-intervention period compared to the pre-intervention period, however, internal medicine providers saw a 5.4% increase in generic prescribing compared with family medicine providers for all three medications combined, including 10.5% for beta blockers and 4% for statins.

The result for proton-pump inhibitors, essentially a 2.1% increase, was not statistically significant.

"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 explained. "The lessons from this study can be applied to other clinical decision efforts to reduce unnecessary health care spending and improve value for patients."