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Survey: Formulary Placement Has Greater Importance as Clinicians Use E-Prescribing

Physicians prescribe drugs with lower patient costs and fewer restrictions (Mar. 14)

Decision Resources, a research and advisory firm based in Burlington, Mass., finds that, on average, surveyed U.S. endocrinologists and primary care physicians (PCPs) use e-prescribing for 76% of their Medicare patients and for 79% of their non-Medicare patients — figures that are expected to grow in the next year. The rates are higher for their use of electronic medical records (EHRs).

Within their e-prescribing programs, roughly 60% of physicians said they have access to their patients’ formularies. These physicians reported that they have easy access to formularies for most of their patients and that this knowledge results in them paying more attention to patient costs.

In addition, approximately 80% of PCPs and endocrinologists said that they would prescribe a less-expensive intravenous dipeptidyl peptidase 4 (DPP-IV) inhibitor, or gliptin, to their patients with type 2 diabetes or hypertension, reflecting a high sensitivity to costs. Among the DPP-IV inhibitors, physicians overwhelmingly prescribe Januvia (sitagliptin, Merck) more often because of its favorable reimbursement while they are reducing their use of Tradjenta (linagliptin, Boehringer Ingelheim) and, to a lesser extent, Onglyza (saxagliptin, Bristol-Myers Squibb). This finding reflects the high rate of preferred coverage for Januvia in comparison with Tradjenta and Onglyza.

The report also finds that, similar to the responses from physicians, pharmacy directors in managed care organizations (MCOs) said that prescribing of Januvia has increased because of the e-prescribing program, whereas branded rivals Onglyza and Tradjenta have faced reduced prescribing. Moreover, 84% of MCO pharmacy directors have seen physicians prescribe drugs with lower patient costs and fewer restrictions because of the information provided in e-prescribing solutions.

According to the new findings, e-prescribing and EHRs represent a challenge to marketers of branded drugs. By providing access to formulary information, including copay amounts, marketers are leading physicians to prescribe the best-reimbursed drug. As a result, formulary placement takes on greater importance.

“The vast majority of physicians say their electronic health records systems only have patient information from their own physician group, meaning they have incomplete information on their patients. This lack of shared information represents a shortcoming of current EHR adoption and prevents improved patient management,” said analyst Roy Moore. “The ability of EHRs to aggregate data and to allow population health management — an underutilized feature today — will allow marketers of branded therapies to demonstrate the superiority of their products versus other competitors and generics. The desire of physicians and MCOs to reduce costs and hospitalizations should make them receptive to clinical data showing therapies’ effectiveness along these metrics.”

Source: Decision Resources; March 14, 2013.

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Decision supported by data from more than 4,000 patients