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the patient is more likely to know that the prescription has a lower out-of-pocket cost. When you combine this with the fact that it will be electronically routed to the phar- macy – which makes it more convenient for the patient and provides more information to

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the pharmacist – you have a great opportunity to improve medication adherence.”

Study furthers understanding of prescription abandonment rates Previous studies have found that e-prescriptions have higher abandonment rates than non-e-prescriptions[5]. The Surescripts study confi rms this and adds context by demonstrating that e-prescriptions have higher abandon- ment rates in part because more prescriptions make it to the pharmacy. “Paper prescriptions appeared – at fi rst glance – to have a lower abandonment rate,” says Majkowski. “But historically, the pharmacy could only measure those paper prescriptions that were brought into the pharmacy by the patient. When you consider all of the paper prescriptions that don’t make it to the pharmacy, the true prescription abandonment rate for paper prescriptions is dramatically higher. Our study suggests that, compared to the true abandonment rate of paper prescriptions, e-prescriptions are actually abandoned at a far lower rate.”

Findings suggest e-prescribing will help improve outcomes and lower healthcare costs Today, poor adherence to medication therapy is a large and costly problem in the U.S. The World Health Orga- nization estimates that as many as 50 percent of patients do not adhere fully to their medication treatment[6]. This non-adherence contributes to 125,000 premature deaths annually as well as to other patient safety concerns that cost the healthcare system an estimated $290 billion an- nually in the form of increased hospitalizations and costly complications[7].

A 2011 study found that every dollar spent on improving patient adherence to medication can result in $3 to $10 of savings from reduced downstream medical costs for certain diseases[8]. Given healthcare policy makers’ and industry leaders’ objectives to reduce costs and improve the quality of care, improving medication adherence can be a key lever in achieving those goals.

The Surescripts study suggests that e-prescribing is already

signifi cantly contributing toward meeting the cost and quality of care objectives by improving fi rst-fi ll medication adherence. “There are many contributing factors to medication non- adherence – social, economic, degree of health literacy, sup- port system and still others that we are still learning about,” says Majkowski. “E-prescribing is not a panacea and does not solve for all of these. However, it is evident from the data that

e-prescribing is already positively impacting fi rst-fi ll medica- tion adherence rates and should be considered a powerful tool in the healthcare system’s efforts to address medication adherence and improve patient outcomes.” To view a downloadable graphic detailing the study results, go to


* No patient-identifi able data was used in the analysis. The study was conducted on a retrospective, longitudinal, pre-post basis comparing outcome metrics for electronic prescribing physicians (test group) vs. non-electronic prescribing physicians (control group). The study involved more than 50,000 active prescribers (representing test and control physicians) across 50 states using over 200 e-prescribing applications, four different pharmacy and PBM organizations, and de-identifi ed data sets representing over 40 million prescription records. Data was ana- lyzed over a three-year period, from 2008 to 2010. To account for seasonal and macroeconomic infl uences on prescribing patterns, baseline data was collected for all test (electronic prescribing) and control (non-electronic prescribing) physicians prior to the time of adoption and compared to results following adoption; the pre and post periods were determined by the time of e-prescribing adoption by the test group physicians and a pseudo-adoption date randomly generated for each control group physician. Criteria for inclusion in the test group included adoption of e-prescribing technology during the 2009 calendar year.


1. World Health Organization. Adherence to long-term thera- pies: evidence for action. Geneva: WHO, 2003. 2. Thinking Outside the Pillbox: A System-wide Approach to Improving Patient Mediation Adherence for Chronic Disease. NEHI (August 2009).

3. Fischer, M.A., Stedman, M.R., Lii, J., Vogeli, C., Shrank, W.H., Brookhart, M.A., & Weissman, J.S. (2010). Primary medication non-adherence: Analysis of 195,930 electronic prescriptions. Journal of General Internal Medicine, 25 (4), 284-290.

4. Shrank, W.H., Choudry, N.K., Fischer, M.A., Avorn, J., Powel, M., Schneeweiss, S., Liberman, J., Dollear, T., Brennan, T.A., Brookhart, M.A. (2010). The Epidemiology of Prescriptions Abandoned at the Pharmacy. Annals of Internal Medicine, Vol. 153, No. 10, 633 – 640. 5. Shrank, ibid.

6. World Health Organization. Adherence to long-term thera- pies: evidence for action. Geneva: WHO, 2003. 7. Thinking Outside the Pillbox: A System-wide Approach to Improving Patient Medication Adherence for Chronic Disease. NEHI (August 2009).

8. M. Christopher Roebuck, Joshua N. Liberman, Marin Gemmill-Toyama and Tryoen A. Brennan. Medication Adherence Leads To Lower Health Care Use And Costs Despite Increased Drug Spending. Health Affairs, 30, no. 1 (2011):91-99.


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