Using default options to increase generic medication prescribing rates


Each year, physicians write millions of medication prescriptions for patients. When available, generic medications are less expensive and as effective as brand name formulations. Studies have also found that patients are more likely to be adherent to generic medications. However, for a variety of reasons, physicians often prescribe the brand name medication. Several studies have found that this contributes to hundreds of millions of dollars of unnecessary spending in federal programs including Medicare and Medicaid.


We conducted a series of studies evaluating how prescription default settings impact physician prescribing patterns.


In a pilot study of internal medicine practices at Penn Medicine, we found that changes to medical display defaults in the electronic health record resulted in higher rates of generic prescribing. After reviewing these findings, default settings were further refined and then launched throughout all practices among all specialties at Penn Medicine. Before the intervention, the generic prescribing rate at Penn Medicine was steadily hovering around 75%. Immediately after the change in defaults, the generic prescribing rate increased to 98.4%.  

We evaluated prescription rates 2.5 years later and found that the impact was sustained. We estimate that for the top 75 most frequently prescribed medications; this change has saved more than $32 million over 2.5 years.

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