The 2024 Nudges in Health Care Symposium will take place September 26–27 in Philadelphia. Learn more and register

Default Options to Increase Generic Prescribing Rates

Default Options to Increase Generic Prescribing Rates

Project status



Kevin Volpp, MD, PhD

Susan Day, MD

John Howell, MD

Scott Halpern, MD, PhD

Bill Hanson, MD

Innovation leads


National Institute on Aging


Each year, physicians write millions of prescriptions for patients. When available, generic medications are equally as effective, less expensive, and have better long-term adherence rates than brand-name formulations. Still, physicians often prescribe brand-name medications, contributing to hundreds of millions of dollars of unnecessary spending in federal programs, including Medicare and Medicaid.


We launched a pilot at Penn Medicine to explore if defaults could increase generic prescribing rates among internal medicine providers. 

Up until this point, when providers went to prescribe a medication in the electronic health record (EHR), they were shown brand and generic medications in one list. During the pilot, we changed the default settings so that only generic medications were offered and required providers to opt out if they wanted to see the complete list.


Before the intervention, the generic prescribing rate at Penn Medicine was steadily hovering around 75 percent. Immediately after the change was made, the generic prescribing rate increased to over 98 percent. This outcome led Penn Medicine to scale default settings for generic prescribing throughout all practices across all specialties.

When we evaluated prescription rates two and a half years later, we found that the impact was sustained. This simple change is estimated to have saved Penn Medicine more than $32 million during that time span.