Driving Market Share in an Integrated Health System without Therapeutic Interchange

OBJECTIVE: Shift selective serotonin reuptake inhibitor (SSRI) market share in a large integrated health system to a more cost-effective alternative without the need for therapeutic interchange. SETTING: University of California Davis Medical Group (UCDMG). PRACTICE INNOVATION: Integrate the managed care team into the routine operation of the medical group clinics. Influence prescribing patterns by a program of continuous physician education, giving the messages that (1) citalopram was the most costeffective SSRI; (2) fluoxetine is the least cost-effective, especially at doses above 20 mg; and (3) that citalopram should be considered as initial therapy for depression and for patients not achieving optimal therapy on their current SSRI. OUTCOMES MEASURES: Change in market share for SSRIs: prescriptions for citalopram and fluoxetine were monitored for a year after the physician education program began. RESULTS: Market share for citalopram increased dramatically. Starting below the reported national usage, t...