POCP Blog

By Michael Burger, Senior Consultant

Policymakers, payers and providers view health information technology (health IT) as a tool to help improve patients’ medication compliance, among its many benefits. This is important because patient non-compliance with their drugs costs billions of dollars annually in unnecessary care, adverse outcomes and deaths. 

Research that investigates the relationships between health IT, costs and patient outcomes slowly is emerging. Findings are mixed. For example, a new study published at Biomed Central, explored, in part, whether a formulary decision support (FDS) function in an ePrescribing system might improve patient compliance and reduce costs. 

Using claims data from 2004 and 2005, the researchers examined the impact of ”non-interruptive” vs. “interruptive” FDS on patient compliance for angiontensin receptor blockers and inhaled steroids. In the end, it apparently didn’t matter which FDS method was used because there was no real impact on patients’ compliance or out-of-pocket costs.  It appears to us that this finding was less a result of the FDS method, but more to do with the study medications, which had only marginal price differences between them.The researchers noted that in order to impact cost-related non-adherence, formulary decision support will likely need to be paired with complementary drug benefit design.

The study did show an impact of FDS on brand selection at the point of prescribing, since generic alternatives were not available for the study medications. In the study, depending on the ePrescribing system that was used, non-interruptive FDS displayed a symbol indicating that an alternative was available. The interruptive FDS was more directive, automatically displaying a message suggesting that prescribers consider specific alternatives.  Study results indicated that prescribing decisions were more directly influenced by the interruptive FDS. This suggests that FDS might be a tool to help physicians choose among brands; however, more work needs to be done to better understand the effectiveness of formulary representation and messaging on prescribing decisions.

To our mind, the study also illuminates the challenges that such research designs and findings pose for policymakers and vendors owing to the age of the data that were used and the technological advances that have taken place since then. The researchers used 2004 Horizon Blue Cross/Blue Shield data from prescribers using a standalone ePrescribing application (iScribe), and 2005 claims data from Caremark. The vast majority of ePrescribing is done within EHRs today.  Formulary decision support and formulary status in ePrescribing systems—standalone and EHR — have come a long way in the intervening years. While studies based on happenings of a decade ago are instructive in today’s world, they clearly lack the value of studies grounded in current data and technology.  We hope the researchers get a chance to try this study again, using more current information from claims and from EHRs themselves. 

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• eMedication Management
• ePrescribing