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.

Using behavioral economics to improve health care quality

David Asch discusses the benefits of using behavioral economics to improve health care quality and provides real-world examples of its successful applications, including the Nudge Unit's work to implement default options to increase generic medication prescribing rates.

No winks. But Penn ‘nudges, nudges’ clinicians, patients to better decisions.

Mitesh Patel talks with Managed Care about the value embedded nudge units can bring to health systems.

For better health care embrace irrationality

In his 2018 TEDMED talk, David Asch asserts, “Changing someone’s mind with information is hard enough, changing their behavior with information is harder still. The only way we are going to make substantial improvements in health and health care is to make substantial improvements in the behavior of health and health care.”

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.