Dr. Lipton discussed two strategies used by physicians to affect patients' prescription drug utilization:
- Physician groups' financial risk for HMO patients' drug costs. Physician groups throughout the country have been losing the battle in managing financial risk for HMO patients' drug costs, largely because they do not have sufficient information or control. As a result, physician groups are now trying to eliminate (or reduce) their financial risk for HMO patients' drug costs. They are moving away from capitation contracting toward "incentivized" pharmacy contracts based on formulary compliance, generic drug fill rates, etc.
- Hand-held, electronic, point-of-prescribing devices. Palm Pilots or other hand-held, electronic, point-of-prescribing devices have the potential (1) to reduce medication errors through enhanced legibility and electronic identification of potential drug therapy problems; (2) to enable physicians to access data on patient compliance, improving ability to improve outcomes; (3) to maintain a complete record of client transactions; and (4) to provide physicians immediate feedback on availability of formulary and generic drugs, with the potential to decrease costs. Dr. Lipton recommended independent controlled research trials to assess the impacts of e-prescribing technologies (e.g., hand-held e-prescribing devices, electronic medical records, and Web-based technologies).