Electronic Prescribing With Formulary Decision Support May Help Reduce Costs

Electronic prescribing with formulary decision support to prescribe medications was effective in reducing costs, according to the results of a study reported in the December 8/22 issue of Archives of Internal Medicine.

"Electronic prescribing (e-prescribing) with formulary decision support (FDS) prompts prescribers to prescribe lower-cost medications and may help contain health care costs," write Michael A. Fischer, MD, MS, from the Harvard Medical School in Boston, Massachusetts, and colleagues. "In April 2004, 2 large Massachusetts insurers began providing an e-prescribing system with FDS to community-based practices."

The investigators conducted a prepost study with concurrent controls using 18 months of administrative data from October 1, 2003, to March 31, 2005, to compare the change in the proportion of prescriptions for 3 formulary tiers before and after e-prescribing began. From these data, they developed multivariate longitudinal models to estimate the specific effect of e-prescribing, after adjustment for baseline differences between intervention and control prescribers. Using average medication costs by formulary tier, the investigators estimated potential savings.

During the study period, more than 1.5 million patients filled 17.4 million prescriptions. E-prescribing was associated with a 3.3% increase (95% confidence interval, 2.7% – 4.0%) in tier 1 prescribing, and the proportion of brand-name prescriptions for tiers 2 and 3 decreased correspondingly in multivariate models that controlled for baseline differences between prescribers and for changes over time.

In the intervention group, e-prescriptions accounted for 20% of filled prescriptions, a rate that could result in savings of $845,000 per 100,000 patients, based on average costs for private insurers. These savings could increase even further with higher levels of e-prescribing use.

"Clinicians using e-prescribing with FDS were significantly more likely to prescribe tier 1 medications, and the potential financial savings were substantial," the study authors write. "Widespread use of e-prescribing systems with FDS could result in reduced spending on medications."

Study limitations include preliminary economic calculations, lack of generalizability to other states and settings, observational design, lack of randomization, and possible residual selection bias.

"Our results suggest that there are important economic gains achievable through the broader use of e-prescribing with FDS but that merely providing e-prescribing systems to clinicians will not necessarily achieve those savings," the study authors conclude. "Rather, prescribers need to adopt the e-prescribing systems fully for these gains to be realized. Making those changes represents an important goal for physicians, insurers, and all those with a stake in the cost of prescription medications."

Source : http://www.medscape.com/viewarticle/584946