ePrescribing: Reducing Costs through In-Class Therapeutic Interchange.

Area of Science:

• Health Economics
• Clinical Informatics
• Pharmacoeconomics

Background:

• US pharmaceutical spending reached $373.9 billion in 2014.
• Therapeutic interchange presents an opportunity for medication cost reduction by substituting prescribed drugs with equally effective alternatives.

Purpose of the Study:

• To evaluate the effectiveness of hard-stop therapeutic interchange alerts within an electronic prescribing tool.
• To quantify the cost savings associated with therapeutic interchange interventions for health plan members.

Main Methods:

• Developed therapeutic interchange alerts for four medication classes: HMG-CoA reductase inhibitors, serotonin receptor agonists, intranasal steroids, and proton-pump inhibitors.
• Calculated the Compliance Ratio (CR) using prescription data from January 2012 to June 2015 to measure intervention effectiveness.
• Analyzed prescription data and medication costs for 45,000 Vanderbilt Employee Health Plan members to assess potential cost savings.

Main Results:

• Significant improvements in CR were observed across all medication classes, with notable increases for proton-pump inhibitors (2.8 to 5.32) and nasal steroids (2.44 to 8.16).
• Combined quarterly savings from the four interventions exceeded $200,000.
• Estimated annual savings for the health plan reached $800,000, averaging over $17 per member.

Conclusions:

• A therapeutic interchange clinical decision support tool integrated into electronic prescribing increased compliance with recommendations.
• The intervention generated substantial cost savings for the Vanderbilt Employee Health Plan, amounting to $17.77 per member per year.
• Effective therapeutic interchange implementation necessitates rational targeting, appropriate governance, and ongoing content updates.