Almost 5% of all prescriptions are designated as “dispense as written” and request a brand name drug, rather than a generic drug. Dispense as written requests for chronic prescriptions have been associated with a 50% – 60% greater odds that patients will not fill the prescription.
Abstract
Background
All US states have adopted generic substitution laws to reduce medication costs. However, physicians may override these regulations by prescribing branded drugs and requesting that they are dispensed as written. Patients also can make these requests. Little is known about the frequency and correlates of dispense as written requests or their association with medication filling.
Methods
We identified beneficiaries of a large pharmacy benefits manager who submitted a prescription claim from any pharmacy in January 2009. We categorized claims as a physician-assigned dispense as written, patient-assigned dispense as written, or no dispense as written. We described rates of these requests and used generalized estimating equations to evaluate physician, patient, treatment, and pharmacy characteristics associated with dispense as written requests. We also used generalized estimating equations to assess the relationship between dispense as written designation and rates prescriptions are not filled by patients.
Results
Our sample included 5.6 million prescriptions for more than 2 million patients. More than 2.7% were designated as dispense as written by physicians, and 2.0% were designated as dispense as written by patients. Substantial variation in dispense as written requests were seen by medication class, patient and physician age, and geographic region. The odds of requesting dispense as written was 78.5% greater for specialists than generalists (PConclusion
Dispense as written requests were common and associated with decreased rates of prescription filling. Options to reduce rates of dispense as written requests may reduce costs and improve medication adherence.
To read this article in its entirety, please visit our website.
— William H. Shrank, MD, MSHS, Joshua N. Liberman, PhD, Michael A. Fischer, MD, MPH, Jerry Avorn, MD, Elaine Kilabuk, BA, Andrew Chang, MPH, Aaron S. Kesselheim, MD, JD, Troyen A. Brennan, MD, JD, Niteesh K. Choudhry, MD, PhD
This article originally appeared in the April 2011 issue of The American Journal of Medicine.
