6/11/2023 0 Comments Iscribe cost![]() ![]() In late 2004, Horizon Blue Cross Blue Shield of New Jersey (BCBSNJ) led an initiative to offer subsidized iScribe standalone electronic prescribing (e-prescribing) software to high volume prescribers. ![]() This was a retrospective difference in differences analysis of de-identified records from e-prescribing adopter and non-adopter cohorts before and after FDS implementation. The requirement for informed consent was waived because this was a retrospective analysis of existing health care data in which the researchers did not have access to identifiable patient information that would have allowed patients to be contacted. The RAND Corporation Institutional Review Board approved this analysis. We sought to evaluate whether FDS could reduce patient medication costs, and thereby improve adherence. However, a 2014 issue brief found no direct study of this topic. Evidence of these two relationships suggests that implementing e-prescribing with FDS could improve adherence. Furthermore, lower copayments are known to be associated with improved adherence. Prior research has shown that FDS is associated with increased usage of generic and other lower-tiered medications. This choice could minimize patients’ copayments and thereby improve medication adherence. Our analysis focuses on the potential of electronic prescribing (e-prescribing) with formulary decision support (FDS) to help physicians know, and thus choose, the lowest-tiered medication within a given class. Furthermore, the cost of adherence-related hospital admissions alone has been estimated at $100 billion annually in the US. Furthermore, meta-analysis shows this poor adherence to be associated with increased mortality. Nonetheless, multiple investigators have documented adherence rates of approximately 60%, with little to no improvement over time. Formulary decision support should be studied further, with particular attention to its effect on adherence in the setting of different benefit designs.Īdherence to medications is a critical component of controlling chronic illness. To impact cost-related non-adherence, formulary decision support will likely need to be paired with complementary drug benefit design. In this context, formulary decision support did not significantly increase adherence. ![]() Interruptive formulary decision support shifted prescribing toward preferred tiers, but these medications were only minimally less expensive in the studied patient population. However, we detected no significant direct association between formulary decision support usage and adherence. Medication possession ratio was 8% lower for each $1.00 increase in monthly copayment to the one quarter power (p < 0.0001). Preferred-tier claims had only slightly lower mean monthly copayments than non-preferred tier claims (angiotensin receptor blocker: $10.60 versus $11.81, inhaled steroid: $14.86 versus $16.42, p < 0.0001). ![]() non-preferred tier) when both non-interruptive and interruptive formulary decision support were in place (OR 1.9, p = 0.04), but no more likely to prescribe preferred-tier when only non-interruptive formulary decision support was in place (p = 0.90). ResultsĬompared with non-adopters, high users of e-prescribing were more likely to prescribe preferred-tier medications ( vs. Last, we modeled the effect of copayment on adherence (proportion of days covered) to each new medication. Second, we modeled the effect of formulary tier on prescription copayment. A difference in differences design was used to compare the pre-post differences in medication tier for each new prescription attributed to non-adopters, low user (30% usage rate). Subsequently, interruptive formulary decision support alerts also interrupted e-prescribing when preferred-tier alternatives were available. Formulary decision support was initially non-interruptive, such that formulary tier symbols were displayed adjacent to medication names. We retrospectively analyzed 14,682 initial pharmaceutical claims for angiotensin receptor blocker and inhaled steroid medications among 14,410 patients of 2189 primary care physicians (PCPs) who were offered e-prescribing with formulary decision support, including 297 PCPs who adopted it. We assessed the effect of electronic prescribing (e-prescribing) with formulary decision support on preferred formulary tier usage, copayment, and concomitant adherence. ![]()
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