Doctors may now have a powerful way to help patients avoid heart attacks and strokes—just by changing how they prescribe medication.
A new study from the University of Pennsylvania’s Perelman School of Medicine shows that making 90-day prescriptions the default option in the electronic health system led to thousands more patients getting longer-lasting supplies of statins, a medication used to lower cholesterol and prevent serious heart conditions.
Published in JAMA Internal Medicine, the study used a behavioral science tactic called a “nudge.” In this case, the nudge was a small change to the electronic prescription system that set the default statin prescription length to 90 days, instead of 30 days. This meant that unless a doctor actively changed the order, the longer refill option was selected automatically.
This minor adjustment made a big difference. In 2022, before the change, 71% of doctors were already prescribing 90-day supplies. By 2024, that number had jumped to 91%. Over the course of the study, this led to 7,200 fewer 30-day prescriptions being written.
Statins are used to manage cholesterol and help prevent heart disease, strokes, and heart attacks, especially in people who already have risk factors like hardened arteries or diabetes. But even among patients who have had heart attacks in the past, only about 64% consistently take their statin medications.
That number is even lower—just 38%—among people with diabetes. Previous research shows that people who don’t take their statins regularly are 30% more likely to die than those who do.
Getting a 90-day supply makes it easier for patients to stay on track. According to co-author Dr. Corinne Rhodes, each longer prescription means eight fewer trips to the pharmacy every year per medication.
Fewer trips mean fewer chances to forget a refill, skip a dose, or run out of medication. It also saves time and reduces stress, especially for people managing multiple chronic conditions.
What’s especially exciting about this intervention is that it required no extra effort from doctors. They didn’t need to do anything differently—just let the default settings stay in place. As Dr. M. Kit Delgado, a senior author on the study, put it: “Making the right choice the easy choice” can have a big impact on public health.
The study also had important implications for health equity. At the beginning of the project, Hispanic and Black patients, and those living in lower-income areas, were much less likely to receive 90-day prescriptions.
For instance, just over 50% of Hispanic patients’ doctors prescribed the longer refill, compared to more than 70% for non-Hispanic white patients. By the end of the study, those gaps were gone. Over 90% of patients in every group, regardless of race or income, received 90-day prescriptions.
Dr. Alexander Fanaroff, another co-author, emphasized that the success of this approach shows how small, thoughtful system changes can promote fairness in healthcare. “We can improve health outcomes and reduce disparities without needing more funding or complex programs,” he said.
Thanks to the success of this nudge, Penn Medicine has expanded the default 90-day prescription option to include medications for high blood pressure and diabetes as well.
In summary, this study proves that a simple digital change—setting the prescription default to 90 days—can significantly improve medication access, support long-term health, and close gaps between patient groups. It’s a clear example of how smart design can make healthcare more effective, efficient, and equitable.
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The research findings can be found in JAMA Internal Medicine.
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