Changing physician prescribing behavior: A low-cost administrative policy that reduced the use of brand name nonsteroidal anti-inflammatory drugs

Background. In the United States, expenditures for prescription drugs are rapidly rising. There is concern that physicians do not prescribe medications in the most cost-saving manner. The objective of this study was to determine if a low-cost administrative intervention would decrease the use of brand name nonsteroidal anti-inflammatory drugs (bnNSAIDs). Methods. A before-after trial of an administrative intervention to change prescribing behavior at an urban public hospital and its satellite clinics was performed. We evaluated all filled NSAID prescriptions, a total of 127,925, over an 8.5- month period before and after the intervention. The intervention requested physicians to complete a short form listing two generic name nonsteroidal anti-inflammatory drugs (gnNSAIDs) that the patient had already tried if they wished to prescribe a bnNSAID. Results. During the 8.5 months before any intervention, 10.5% of 65,404 NSAID prescriptions were written as brand name prescriptions. For the 8.5 months during the intervention, physicians wrote 62,521 NSAID prescriptions, of which 6.9% (4,322/62,521) were brand name. This represents a 34% decrease in bnNSAID prescriptions (P < 0.0001). Using the average pharmacy acquisition costs for bnNSAIDs and gnNSAIDs, as well as the percentage of decrease in bnNSAID use, we calculated the cost savings to the institution to be $92,914 for the 8.5 months, or a projected annualized savings of $131,172. The decline in bnNSAID prescriptions was site specific; settings in which house staff were supervised by attending physicians had a greater decline when compared to community-based primary care physicians (P < 0.05). Conclusion. A low-cost administrative intervention can have a significant impact on physicians' prescribing habits of NSAIDs and result in cost savings to the institution.