EPN - Electronic Prescribing News

According to a recent study by Medco Health Solutions, Inc. that used a historic sample of its pharmacy claims, generic substitution increased 2.7% and formulary compliance rose 3.4% in the six months after a physician group implemented e-prescribing. Medco concluded that physicians using e-prescribing technology were "more than two times as likely as the comparison group to trigger an intervention at the pharmacy encouraging generic or formulary usage where appropriate."
Some of the health plans that have already adopted e-prescribing programs are Horizon BCBSNJ, Tufts Health Plan and Blue Cross Blue Shield of Massachusetts (as part of eRx Collaborative), Group Health Incorporated and WellPoint Health Networks, Inc.
The first phase of Horizon BCBSNJ's e-prescribing initiative was a pilot conducted from June 2001 into early 2002 using personal digital assistants (PDAs) from ePhysician. Physician utilization of the handheld hardware wasn't very significant, but the health plan did see a slight increase in formulary compliance and generic dispensing, Patel tells DBN. To measure the value of the PDAs that it provided at no charge to a target group of physicians, the New Jersey Blues plan tracked the impact of FDA alerts and National Cholesterol Education Program guidelines that it messaged to physicians, looked at pharmacy patient and physician satisfaction surveys, and monitored compliance and generic dispensing rates. The slight increases in compliance and generic rates were not statistically valid because of low physician utilization, notes Patel, but the trend looked promising.
The pilot focused mainly on high-prescribing physicians, but now the company's strategy is "to put these physicians into different buckets," says Patel. In other words, the company has grouped them into physicians who use Palm Pilots vs. those who are inclined to use the Internet on their office computers. Horizon's latest initiative, which started in October 2003 through a partnership with AtlantiCare Health System and Caremark Rx, Inc., provides Caremark-owned iScribe technology to physicians in either a Web-based or handheld format complemented by formulary and clinical information from ePocrates.
The Web-based capability features patients' Rx history and allows the prescriber to coordinate prescription refills and renewals through the retail and mail-service pharmacies. The PDA, on the other hand, has an e-prescribing capability that features connectivity to pharmacies, potential drug interactions based on the member's Rx history, and messaging. Both tools have universal formulary reference, with access to more than 3,000 formularies. The formulary data are provided to iScribe by InfoScan, a national vendor of health plan drug coverage information.
BCBSNJ's target goal is 350 active users of the iScribe technology, according to Patel. To date, 85 Horizon network physicians have used the tools to write more than 150,000 prescriptions.
Multipayer Soultion Is Most Desirable
E-prescribing technology can be particularly advantageous to health plans if it is a "multipayer solution" (i.e., it allows doctors to view multiple formularies) and if the device includes patient medication history and allergies as well as drug interaction information, says Patel. There is no such tool now that combines all of those capabilities since it is difficult to obtain all health plan information, but there are versions that come close, including iScribe, he says.
Based on the literature available, Patel says the company's conservative expectations are that formulary compliance will increase about 2% to 3% and generic dispensing rates will increase 3% to 4%, but the health plan will do a complete analysis after one year. Other metrics that health plans can use are mail-order utilization, nonfulfillment rates and reduction of ADEs, adds Patel.
To buy a CD recording of the Sept. 30 audioconference, "New E-Prescribing Strategies for Health Plans," call (800) 521-4323 or visit www.AISHealth.com.