Computerized Alerts Help Reduce High Cost of Prescribing Name Brand Drugs

Photo: Robert J. Fortuna, senior instructor of Pediatrics and Internal Medicine at the University of Rochester Medical Center.

Electronic alerts persuade clinicians to switch from costly drugs to generic brands.

Simple computerized alerts can help curb the impulse to prescribe unnecessarily expensive, heavily marketed drugs, according to a study in the August issue of Journal of General Internal Medicine. The study found that when clinicians received computerized alerts, which compared medication brands, they changed 23.3 percent of prescriptions for four heavily marketed sleep medications to comparable generic equivalents.

The alerts provided links to supplementary information, including supporting evidence for the recommendations, specific co-payment information and patient educational materials about sleep hygiene and insomnia. They were triggered when a new prescription for a heavily marketed drug appeared in the electronic health records system.

"Prescription drugs remain a key component of health care expenses, totaling more than $216 billion per year. If we can reduce unnecessary prescriptions for high-priced, heavily marketed drugs that are prescribed, we can directly lower some of the high costs associated with health care," said Robert J. Fortuna, M.D., M.P.H., a senior instructor of Pediatrics and Internal Medicine at the University of Rochester Medical Center.

Some clinicians received computerized alerts while others received alerts accompanied with educational sessions and a third control group of clinicians received no alerts. The two groups of clinicians who received alerts were much less likely to start newly prescribed patients with name brand drugs. Fortuna said that once a patient has already been prescribed a medication, it can be difficult to persuade the patient to change to a new medication, which explains why a steady rate of name brand prescriptions still persisted among the groups who received interventions. Overall, the alerts were well received by clinicians and many reported that it prompted discussion regarding costs and alternative therapies with patients.

Researchers followed the prescription rates of Ambien CR, Lunesta, Sonata and Rozerem between 2006 and 2008. In 2007, total sales of Ambien CR and Lunesta, the top two heavily marketed hypnotic medications topped $1.3 billion.

The study was developed after a lawsuit against a pharmaceutical manufacturer in 2004 led to the creation of the Consumer and Prescriber Education Grant Program, which funded the study. The study was one of the programs's early initiatives.

The study's authors had access to prescribing data through a direct query of Harvard Vanguard Medical Associates (HVMA) Epic electronic health records so they could monitor what drugs the participating clinicians prescribed. All of the clinicians monitored in the study practiced in internal medicine within HVMA.

"As medical facilities move toward electronic health records, there will be more opportunities to provide computerized support to clinicians about drug prescriptions," said Fortuna. "We hope that electronic health records will provide a vehicle for delivering readily available, relevant information to clinicians so that name recognition won't be weighted so heavily when it comes to prescribing medications."