Nudge Theory and Prescriptions

There is a story about nudge theory and electricity bills that basically states in an area they trialled putting not just the customer’s bill but also the average bill in the area on the invoice to give an example of how much the customer could be saving. So as a customer you would see that your electricity bill was £800 but the average in your area was 500 and this will give you an incentive to save electricity. Apparently worked particularly for those who were more than the average however it didn’t particularly incentivise those below the average. Then they tried not only putting the average bill in the area but the cheapest bill as well. Apparently, this worked even better in that it incentivised everybody including those already better than average to try and achieve the best and introduce an element of competition.

It’s always struck me that we could do something similar with prescriptions. While every time I prescribe a medication I see its price though often in a tiny font is difficult to see and we have software like ScriptSwitch or optimiseRX that flash up big boxes saying “did you know a cheaper alternative exists?” The patient never sees this. Why not? While I’m not suggesting the patient pays the full cost of the prescription why shouldn’t they know how much the drugs there are on are costing? Or that the inhaler they press a couple of times just to make sure it’s working costs 60 quid or that bottle of laxatives that they order over and over again but don’t take costs a fiver a bottle.

My first wish would be on the prescriptions or on the label of the medication it actually states the cost to the NHS of that medication. I’d actually also include the indication for the medication as it’s amazing how many people don’t really know why they’re on something. You say to them for example which your tablets are your BP tablets and they’ve no idea. How can you achieve concordance if people don’t know what they’re taking for what reason?

My second wish might be that we use nudge theory to help encourage people to ask the cheaper medication. So on the prescription or on the packaging, it should say something like did you know a cheaper alternative that is just a good exists that would save the NHS X?

At the moment is a huge amount of time and trouble is gone to trying to switch patients onto cheaper medication. We regularly have a member of the medicines management team sat in our surgery bringing patients or leaving them notes or messages trying to convince them to change to a new drug. Our pharmacists do the same doctors do the same. It’s a very paternalistic approach. While some patients seem to have got used to it and accept it, why not use nudge theory? Why not have them asking for the cheaper medication? Why not have them understand how much their medications actually cost?

I can’t see that it would require that much programming, particularly as this type of software, already exists and all the prices are known.

I’m interested to know if any area has tried anything like this?

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