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The consequences of requesting "dispense as written"
William H Shrank1, Joshua N Liberman, Michael A Fischer
1Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA. wshrank@partners.org
The American Journal of Medicine
|March 26, 2011
Summary
Dispense as written requests, initiated by physicians or patients, are common and linked to lower prescription fulfillment rates. Reducing these requests may improve medication adherence and lower healthcare costs.
Area of Science:
- Health Economics
- Pharmacoepidemiology
- Medication Adherence
Background:
- Generic substitution laws aim to reduce medication costs across US states.
- Physicians and patients can override generic substitution by requesting branded drugs be dispensed as written.
- Limited data exists on the frequency, predictors, and impact of dispense as written requests on prescription filling.
Purpose of the Study:
- To investigate the frequency and correlates of dispense as written (DAW) requests.
- To assess the association between DAW designations and prescription non-filling rates.
Main Methods:
- Analysis of 5.6 million prescriptions from a large pharmacy benefits manager in January 2009.
- Categorization of claims into physician-assigned DAW, patient-assigned DAW, or no DAW.
- Use of generalized estimating equations to identify factors associated with DAW requests and their impact on prescription filling.
Main Results:
- Over 2.7% of prescriptions were physician-assigned DAW and 2.0% were patient-assigned DAW.
- DAW request rates varied significantly by medication class, patient/physician age, and region.
- Specialists had 78.5% higher odds of requesting DAW compared to generalists.
- Both physician and patient DAW requests were associated with significantly higher odds of prescriptions not being filled (OR 1.50 and 1.60, respectively).
Conclusions:
- Dispense as written requests are prevalent and negatively impact prescription filling rates.
- Reducing DAW requests could potentially lower healthcare expenditures.
- Strategies to decrease DAW requests may enhance medication adherence and improve patient outcomes.
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