Using default options to increase generic medication prescribing rates

Opportunity

Each year, physicians write millions of medication prescriptions for patients. When available, generic medications are as effective, less expensive, and have better long-term adherence rates than brand-name formulations. Still, physicians often prescribe brand-name medications. Several studies have found that this contributes to hundreds of millions of dollars of unnecessary spending in federal programs, including Medicare and Medicaid.

Approach

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

Impact

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 generic prescribing rates. Based on what we learned during pilots, default settings were applied throughout all practices across all specialties at Penn Medicine. Before the intervention, the generic prescribing rate at Penn Medicine was steadily hovering around 75 percent. Immediately after the change in defaults, the generic prescribing rate increased to 98.4 percent.  

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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Watch the video to learn how we might harness our innate human irrationality to create positive behavior change, and learn more about the Nudge Unit project Asch references.