Articles on Pharmacy Benefit Management

Featured Health Business Daily Story November 5, 2007

Aetna's E-Prescribing Pilot Causes Increases in Generic Drug Prescriptions and Formulary Compliance

Reprinted from DRUG BENEFIT NEWS, biweekly news, data and business strategies for health plans, PBMs and pharmaceutical companies.

An e-prescribing pilot program conducted by Aetna, Inc. in New Jersey and Pennsylvania boosted physicians' generic drug prescribing rates by 7% and formulary compliance by 5%, according to the health insurer. Meanwhile, a separate study conducted by SureScripts and Walgreen Co. found an 11% increase in new prescriptions filled at the pharmacy when physicians use e-prescribing rather than write paper prescriptions.

These findings are the latest to show that e-prescribing offers both health benefits and a return on investment (ROI), say health plan and PBM executives.

The Aetna pilot program, conducted with technology vendor Zix Corp., provided 1,000 hand-held devices and service to network providers in New Jersey and eastern Pennsylvania. The pilot, which started in July 2005 and had results reported Oct. 8, targeted doctors who see a large percentage of patients with Aetna coverage, the companies said.

The 7% increase in generic utilization demonstrates the value of e-prescribing in connecting a health plan with its network physicians, says Ed Pezalla, M.D., national medical director of Aetna Pharmacy Management.

"That is one of the good things about e-prescribing," Pezalla tells DBN. "It puts more information in the physician's finger tips, and makes them more connected to our formularies. In the future, perhaps we'll even have some areas where we do even less management, because the physicians already are making good choices."

While the pilot program did not survey physicians' attitudes toward e-prescribing, the feedback from medical directors was positive, Pezalla says. "We had pretty high uptake here," he adds. "About only 5% of physicians nationwide are adopting or planning to adopt e-prescribing soon. We had uptake of close to 20%."

Based on the early success, Aetna and Zix have expanded the program to New York and Connecticut, and have provided hand-held devices to an additional 750 doctors.

Horizon E-Prescribing Generates ROI

Several e-prescribing initiatives run by Horizon Blue Cross Blue Shield of New Jersey are showing similar results. The programs now have 1,400 participating physicians.

Horizon's most recent effort has been as regional sponsor for the National ePrescribing Patient Safety Initiative, a coalition of large technology companies and health care organizations that are providing free access to electronic prescribing. "We're providing Web-based e-prescribing to any physician here in New Jersey for free," says Mihir Patel, M.D., manager of pharmacy business development at Horizon.

"We definitely are seeing a good return on investment," he tells DBN, noting that a study is under way to determine the exact ROI figure, along with other effects of e-prescribing, including generic dispensing rates and the impact on hospitalizations.

The e-prescribing tools cost Horizon between roughly $3,000 and $7,000 per physician, depending on what technology is provided, such as printers or wireless networks. "Yes, we have data that shows it's worth that investment," he says, pointing to increases in generic dispensing rates, formulary compliance and mail-order utilization.

Patel says that health plans have learned from initial e-prescribing efforts in 2003 and 2004. "You can't really provide a physician with a tool that they can only use with your health plan," he says. "They really have to provide [doctors] with a versatile tool that they can use with all of their patients."

In North Carolina, more than 1,000 doctors statewide now use free e-prescribing technology provided by Blue Cross and Blue Shield of North Carolina (BCBSNC). The Blues plan's "ePrescribe" initiative, which was launched in January 2006, tells physicians at what level a medication is covered by the patient's insurance drug plans, and also prompts doctors to prescribe generic drugs when available. Among the results of the program:

• 59% of e-prescriptions were written for a generic drug;
• 29% of e-prescriptions alerted prescribers of a potential drug-drug interaction, and;
• 2% alerted prescribers of potential drug-allergy interactions, resulting in many of those prescriptions being changed or canceled.

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