WOONSOCKET, R.I. — "Dispense-as-written" prescriptions are exacerbating medication nonadherence and costing the U.S. healthcare system billions of dollars, according to a new study by researchers at Harvard University, Brigham and Women's Hospital, and CVS Caremark.
According to the study, published this week in the American Journal of Medicine, researchers found that DAW designations for prescriptions — a practice whereby doctors or patients demand the dispensing of a specific brand-name drug and not a generic alternative — costs the healthcare system up to $7.7 billion annually.
The study estimates that patients would have saved $1.7 million and health plans would have spent $10.6 million less for the medications if effective generic alternatives had been provided in place of brand-specific medications. Assuming a similar rate of DAW requests for the more than 3.6 billion prescriptions filled in the United States annually, patient costs could be reduced by $1.2 billion, and overall health system costs could be reduced by $7.7 billion.
Researchers also found that when starting new essential therapy, particularly among chronically ill patients with DAW prescriptions, patients were 50% to 60% less likely to actually fill the more expensive brand-name prescriptions than generics.
"Previous to this study, little was know about the frequency with which doctors and patients request dispense-as-written prescriptions," stated Troyen Brennan, EVP and chief medical officer of CVS Caremark and a study author. "Those who advocate for dispense-as-written and argue that the practice provides patients and physicians with greater choice will probably be surprised to learn that the practice increases costs and exacerbates nonadherence."
The study reviewed 5.6 million prescriptions adjudicated by CVS Caremark for 2 million patients from Jan. 1 to 31, 2009. The review found that 2.7% of those prescriptions were designated DAW by doctors, while another 2% were requested DAW by patients.