Generic Prescribing Increases with EHR Default Display Change

Health care providers are much more likely to select a generic drug when their electronic health record (EHR) system displays generics by default.

A recent study published in JAMA Internal Medicine found that using an EHR system that automates prescribing of generic medications led to a 23.1% overall increase in generic prescribing rates.

Researchers used prescription data from outpatient clinics within the University of Pennsylvania Health System between January 2014 and June 2015. The EHR system change was implemented among all specialties, and data were analyzed for oral medications most often prescribed for 10 common conditions: seizure, pain, hypothyroid, acid reflux, anxiety/insomnia, bacterial infection, hypertension/congestive heart failure, hyperlipidemia, depression, and diabetes.

A checkbox was added to the EHR default prescription screen so that a prescriber wishing to select a brand-name drug would have to manually uncheck the box. Otherwise, the generic was automatically prescribed.

Prior to implementing this default selection, generics accounted for 75.3% of total prescriptions written across the health system. After its implementation, however, the health system’s generic prescribing rate reached 98.4%.

This finding suggests that prescribing a brand-name drug when a generic version is available may very well be a matter of convenience for prescribers, rather than a conscious choice. Implementing EHRs with generic default displays has the potential to change prescribing behaviors on a wider scale, which could lower costs across the entire health care spectrum in turn.

“The growing adoption of [EHRs] brings new opportunities to improve physician decision making toward higher-value care,” the study authors wrote.

In fact, another study published in JAMA found that patients prescribed and dispensed a brand-name drug instead of an equivalent generic version spent an estimated total of $24.6 billion in excess prescription drug costs between 2010 and 2012.

On the other hand, the current study authors cautioned that automated generic prescribing isn’t a “one-size-fits-all” intervention that will always change prescribing behaviors.

For example, an earlier study by the same researchers involving EHR display changes showed a mere 5.4% increase in generic prescribing rates when the default screen was changed to display only generics. In that intervention, prescribers could click on another tab to see a list of all brand-name therapies.

“Our findings indicate that the manner that default options are designed and implemented has an important influence on their effectiveness for changing physician behavior,” the researchers concluded.

Another important factor that wasn’t considered in either study was the degree to which patients requested a brand-name drug over a generic equivalent. A separate investigation revealed that more than one-third of physicians in a national survey acknowledged that they sometimes or often go along with patient requests for a brand-name drug even when a generic version is available.

As medication experts, pharmacists can make sure patients are aware of cheaper medications in the same drug class that are FDA-approved for the same indication.