Effect of Electronic Prescribing With Formulary Decision Support on Medication Use and Cost

[Guest guest]

This probably only confirms that (as some have suggested), it costs us money, but saves the insurance companies money on their side, so why aren't they paying for it, but...here is an article.

It appears the insurers paid for the eRx in this case.

Interestingly, only 20% of Rx's were eRx in the intervention group.

$845 000 per 100 000 patients savings -- which I guess is $8.45/patient savings?It's not clear how the 18month time frame was divided -- was 18months the time frame for the study or was 9months studies w/o eRx and 9month with.

Anyway, assuming 18months of study -- the $8.45 savings/patient is $5.63/patient/year.

Not a huge savings on an individual basis, but I guess it adds up if you are an insurance company covering 1,000's of lives.

Or if you look at it this way -- the average money spent in 2003 was $5,711 -- so if you save $5.63, then you decrease the cost by $5.63/$5,711 = 0.1% savings to the system -- but more likely to the insurance company.

http://archinte.ama-assn.org/cgi/content/abstract/168/22/2433

Vol. 168 No. 22, Dec 8/22, 2008

Effect of Electronic Prescribing With Formulary Decision Support on Medication Use and Cost A. Fischer, MD, MS; Vogeli, PhD; Margaret Stedman, MPH; Ferris, MD, MPH; M. Alan Brookhart, PhD; S. Weissman, PhD

Arch Intern Med. 2008;168(22):2433-2439.

Background Electronic prescribing (e-prescribing) with formulary decision support (FDS) prompts prescribers to prescribe lower-cost medications and may help contain health care costs. In April 2004, 2 large Massachusetts insurers began providing an e-prescribing system with FDS to community-based practices.

Methods Using 18 months (October 1, 2003, to March 31, 2005) of administrative data, we conducted a pre-post study with concurrent controls. We first compared the change in the proportion of prescriptions for 3 formulary tiers before and after e-prescribing began, then developed multivariate longitudinal models to estimate the specific effect of e-prescribing when controlling for baseline differences between intervention and control prescribers. Potential savings were estimated using average medication costs by formulary tier.

Results More than 1.5 million patients filled 17.4 million prescriptions during the study period. Multivariate models controlling for baseline differences between prescribers and for changes over time estimated that e-prescribing corresponded to a 3.3% increase (95% confidence interval, 2.7%-4.0%) in tier 1 prescribing. The proportion of prescriptions for tiers 2 and 3 (brand-name medications) decreased correspondingly. e-Prescriptions accounted for 20% of filled prescriptions in the intervention group. Based on average costs for private insurers, we estimated that e-prescribing with FDS at this rate could result in savings of $845 000 per 100 000 patients. Higher levels of e-prescribing use would increase these savings.

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

Locke, MD