Evaluating the Length of Prescription Plans

UK prescription with tablets and stethoscope

A review of clinical and economic evidence, followed by economic modelling, suggests that the NHS should rethink its policies and guidance promoting 28-day vs three-month prescription lengths.

Although a shorter prescription length may reduce medicine wastage, three-month prescriptions were associated with lower administrative costs and improved medication adherence among those with chronic illnesses.

Background

In the British National Health Service, GPs have been encouraged to issue prescriptions of shorter duration, usually 28 days, to reduce drug expenditure and wastage.

There is some evidence to suggest that limiting prescription durations to 28 days results in cost savings by reducing wastage, but there is also some evidence to suggest that shorter prescriptions may increase costs through increased GP workloads and dispensing fees. Prescription length also has important implications for patient satisfaction, with evidence suggesting that patients prefer longer prescriptions.

Overall, the relative effectiveness and cost-effectiveness of shorter versus longer duration prescriptions is uncertain.

Goals

The aim of this review, commissioned by the NHS National Institute for Health Research, was to provide a high-quality reference on the clinical and cost-effectiveness of 3 month vs 28 days prescriptions in patients with stable chronic diseases. Specifically, the research team aimed to evaluate the impact of prescription length on disease-specific measurements, drug wastage, adverse events, patient experience and satisfaction, administration time, pharmacist costs and health outcomes.

Methodology

This study involved three stages. The first two stages consisted of a review of the clinical and economic evidence of the effectiveness and cost-effectiveness of different prescription lengths. The third stage involved economic modelling of the net cost to the NHS from changes in drug wastage, dispensing fees and GP time as a result of the 28-day compared to three-month prescriptions, as well as an estimate of health gains.

Findings

  • The current evidence base does not support policies and guidance promoting shorter prescription lengths over longer prescription lengths.
  • Increasing the length of prescriptions could be most beneficial for people with long-term health conditions. This could also result in substantial cost savings for the NHS.
  • Despite the link between longer prescription lengths and increased waste, switching to longer prescriptions could end up resulting in cost savings, as the biggest impact on cost was the time administrating repeat prescriptions.
  • Longer prescriptions are associated with improved medication adherence. Therefore, there could be clinical benefits to increasing the length of repeat prescriptions for patients with chronic conditions. This could result in further long-term cost savings due to reductions in the use of health services by patients.
  • Further research on the potential associations between cost savings and longer prescription lengths is still required. However, the evidence available suggests that the policy on 28-day prescriptions does at least require a re-think.