Docs Who E-Prescribe Order More Generics, Study Says

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Doctors who have access to formulary information when they prescribe electronically tend to prescribe drugs with lower copays for patients, Decision Resources, a research and consulting firm in Burlington, Mass., said in a new report.

Decision Resources surveyed primary care physicians and endocrinologists who prescribed electronically to at least 25 patients a year, either in their electronic health records (EHRs) systems or in standalone e-prescribing systems. On average, the doctors prescribed online for 76% of their Medicare patients and 79% of their non-Medicare patients.

Sixty percent of the respondents said they had access to health plan formulary information in their e-prescribing systems. Managed care organizations (MCO) provide this information because they want doctors to prescribe lower-cost medications. These are either generic drugs or drugs for which health plans or pharmaceutical benefit managers have negotiated discounts.

[ The number of doctors who e-prescribe has grown 59% in the last six years. ]

The plans also give physicians financial incentives to prescribe generic and other low-cost medications. So, besides wanting to help patients by prescribing drugs with lower copays, many doctors will prescribe formulary drugs to boost their incomes.

In its survey, Decision Resources asked physicians about their prescribing of medications used to treat diabetes and hypertension. These conditions were chosen because they're common and because both brand-name and generic drugs are prescribed for them, said Roy Moore, product manager for Decision Resources, in an interview with InformationWeek Healthcare.

The researchers found that when doctors viewed multiple drugs for diabetes in their e-prescribing program, they tended to select the drug with the lowest copay -- a fact they might not have known before e-prescribing came along. Primary care doctors were more likely to prescribe the low-cost option, Moore noted. That might be because they see a wider variety of patients than endocrinologists do, including many who don't have a severe form of diabetes.

A press release about the study cites a class of drugs known as DPP-IV inhibitors, which are used to treat both diabetes and hypertension. Eighty percent of the respondents said they'd prescribe a less expensive DPP-IV inhibitor to their patients with type 2 diabetes or hypertension.

For example, the physicians preferred Merck's Januvia to Tradjenta (Boehringer Ingelheim) or Onglyza (Bristol-Myers Squibb) because of its more favorable coverage by health plans. MCO pharmacy directors, similarly, say that Januvia prescribing has increased because of e-prescribing programs, while branded rivals Onglyza and Tradjenta have been prescribed less often.

Overall, 84% of MCO pharmacy directors said doctors are prescribing drugs with lower patient costs and fewer restrictions because of the information provided in e-prescribing solutions. Restrictions include prior authorization and step therapy programs, noted Moore.

"Especially if you're dealing with step therapy, doctors would rather not have to go through that process if they have to try metformin, say, before they switch over to something else," he said.

Decision Resources pointed out that, in the short term, e-prescribing "represents a challenge to marketers of branded drugs." Because physicians are likely to use the formulary data to prescribe the best-reimbursed medication, pharmaceutical companies must try to ensure that their drugs are included in formularies. And that strengthens the bargaining position of the managed care organizations.

In the long term, however, Moore observed, the growth of interoperability among EHRs and the availability of clinical information across care settings might benefit drug companies. When the effectiveness of different medications for the same condition can be compared, it will be easier for drug marketers to hawk their wares and justify higher prices for their products, he said.

As large healthcare providers test the limits, many smaller groups question the value. Also in the new, all-digital Big Data Analytics issue of InformationWeek Healthcare: Ask these six questions about natural language processing before you buy. (Free with registration.)