Forget the mixed-up, jumbled crazy world of health care and medical insurance as we know it today and imagine that a different, more streamlined approach to health care were in place.  While imagining this more structured approach to medicine, add the prospect of dramatically reduced expenditures on prescription drugs.  Advocates of electronic prescriptions (e-prescriptions) say that’s possible and they’re using the very impressive results of a study, begun in 2004, as an example of what is possible.

Michael A. Fischer, MD, MS, says a crucial limiting factor in the current system is the many differing formularies insurance plans use to develop a tiered system of consumer copayment for prescription drugs.  One company may offer the best copay rate on a given drug while another company places the same drug in a higher-expense category.  Such differences make it almost impossible for a prescribing physician to know which drug is most cost effective for which patient.

The best example of how nicely the system could work seems to be Fischer’s study, begun in April 2004, in Massachusetts, where he’s affiliated with Brigham and Women’s Hospital and Harvard Medical School.  The study enlisted two large medical insurers who diligently used Fischer’s system of e-prescribing from a three-tiered, color-coded system.  Each color represented a different consumer copay amount.  Fischer’s research team evaluated prescription expense using data from 18 months of study.

About 17.4 million prescriptions were written electronically for more than 1.5 million Massachusetts patients between October 2003 and March 2005.  The least expensive copayments were assigned to drugs designated tier 1 medications, many of which were generic formulas.  Tiers 2 and 3 were progressively more expensive.  Copayment expenses were compared to those provided by private insurers.

Under the e-prescribing system, an average savings of $0.70 per patient per month was realized, a number that seems small in a stand-alone scenario but when calculated to include 100,000 patients, savings total $845,000 per year.  When these figures are projected upon the millions of patients nationwide getting millions of prescriptions each year, the numbers become much more impressive.  Fischer writes that more extensive compliance with the system may generate a projected savings of $3.91 million per 100,000 patients per year.

Fischer’s report on the study, published in the latest issue of the ‘Archives of Internal Medicine,’ indicates optimum success means more than merely having an e-prescribing system in place.  To make the most of such a system, formulary decisions must be adopted in a way that makes e-prescribing easily acceptable across a broad spectrum of medical professionals and it must be utilized to its fullest capacity by physicians, pharmacists, insurers, and any other entity with a stake in prescription drug expenses.

Fischer received a career development grant from the National Institutes of Health and the Agency for Healthcare Research and Quality also supported the study.