January 8, 2013
Survey Finds Doctors Often Prescribe Brand-Name Drugs When Cheaper Generic Is Available
Alan McStravick for redOrbit.com - Your Universe Online
We´ve all seen the advertisements on television. It´s hard not to see them, really. “Be sure to ask your doctor about [insert brand name pharmaceutical here].” And apparently marketing directly to the consumer is a very effective means of gaining market share and, thus, profitability.
But a new study from investigators at the Mongan Institute for Health Policy (MIHP) at Massachusetts General Hospital (MGH) has discovered other reasons why patients might receive a brand-name pharmaceutical when a cheaper generic form of the medication is readily available. Their findings will appear in the journal JAMA Internal Medicine (formerly the Archives of Internal Medicine) and have been published online ahead of the print publication.
The report states that more than a third of U.S. physicians who responded to the national survey claimed that they would bypass available generic medications in favor of brand-name drugs with some regularity. Most often, the reason cited by the physicians was because their patient will have requested the brand-name specifically. However, the survey also indicated that physicians who had a marketing relationship with pharmaceutical industry manufacturers were more likely to accede to patient requests than were physicians who were not in a partnership with the drug companies.
The data shows that approximately four out of every ten physicians reported that they at least “sometimes” comply with requests for brand-name pharmaceuticals even when a generic equivalent is available.
"The good news is that 63 percent of physicians indicated they never or rarely prescribed a brand-name drug instead of an equivalent generic simply because of a patient request. However, our data suggest that a substantial percentage — 37 percent or about 286,000 physicians nationally — do meet those requests," says Eric G. Campbell, PhD, of the MIHP, who led the study. "Since generics are from 30 to 80 percent cheaper than the brand-name versions, that would represent a significant source of unnecessary health costs."
In an accompanying editor´s note to the study, Patrick O´Malley, MD, MPH, of the Uniformed Services University of the Health Sciences at Bethesda, Maryland agreed that opting for brand-name drugs over generics represents an immense and unnecessary cost for patients and healthcare systems.
“Such situations call for systems-level interventions to overcome the irrational cultural practices,” he stated. O´Malley points out that in larger, closed health systems, once a physician has decided on the appropriateness of a drug, the pharmacy will make the final decision on brand-name versus generic.
An example of a larger, closed-health system acknowledged by Campbell´s group was the Veterans Administration (VA). VA pharmacies will typically make the final decision on whether a generic or brand-name drug will be dispensed to the patient. However, physicians still have the ability to override the dispensation of a generic drug when they feel it is absolutely necessary.
The data from the 2009 survey of medical professionalism was submitted to 3,500 physicians nationwide and was distributed evenly across different types of medical practice. 500 each were sent to physicians representing internal medicine, family practice, pediatrics, cardiology, general surgery, psychiatry and anesthesia practices. Of the 3,500 surveys sent out, 1,891 (or 64 percent) were returned to the study investigators.
In the survey, one of the questions asked of the physicians was if, during the previous year, they had “prescribed a brand-name drug when an equivalent generic was available because the patient asked for the brand-name drug specifically.” Physicians were offered the available answers of “never”, “rarely”, “sometimes” or “often”. Approximately 40 percent of the physicians answered with “sometimes” or “often”.
Interestingly, it was found that physicians whose practices had been operational for more than 30 years as well as physicians in solo or two-person practices were more likely than those in younger or group practices to report having filled a patients request for a brand-name drug.
The specific specialty areas that topped the list for brand-name prescriptions were internal medicine and psychiatry. Conversely, pediatricians, anesthesiologists, cardiologists and general surgeons appeared less likely to prescribe a brand-name medication when there was a suitable generic form of the drug available.
It is no surprise that pharmaceutical companies don´t spend all of their marketing money on advertising directly to the consumer. Internal marketing to physicians and their practices is also commonplace. Whether it includes bringing lunch and bags of goodies for physicians and their staffs or stocking their drug closet with a plethora of free drug samples — both highly common marketing practices — drug companies have successfully insured that medical practices are just as familiar with their brand-name drugs as patients are.
It is important to note, however, that the survey found no association found between a physician being invited as an industry-paid speaker at conferences, receiving industry gifts or reimbursement of travel expenses and that physician´s likelihood to favor brand-name prescriptions over their generic equivalents.
"While we cannot prove a cause-and-effect between industry marketing activities and prescribing practices, at the most basic level these data suggest that industry marketing works," says Campbell, a professor of Medicine at Harvard Medical School. "Our results also raise serious doubts about the desirability of meeting with drug company representatives to 'stay up to date'."
TAKING ACTION TO LOWER HEALTHCARE COSTS
Along with the data from the survey results, the study authors also prescribed an action plan that could help to lower the already bloated healthcare costs in the U.S. Part one of their action plan focuses on patient education and helping them to see past the effective drug commercials that they have been exposed to in their homes.
Another aspect addresses the informational blitz to physicians advising them just how wasteful the practice of prescribing brand-name drugs can be when suitable generics are available. And yet another suggestion from the group hopes to do an end-run around the pharmaceutical companies in-house marketing to medical professionals by suggesting that hospitals and health systems begin to require all drug samples be submitted directly to their pharmacies rather than to the prescribing physicians, themselves.
The authors also expressed a few thoughts on those free lunches and gifts too. They recommend a ban on drug company provided food and beverages on all medical premises. They went on to state: “Payers such as Medicare or commercial insurers who are interested in increasing the use of generic drugs may consider banning physicians from accepting food and beverages in the workplace.”
And finally, borrowing from the VA model, they suggest delegating the authority of final decision on brand-name versus generic to pharmacists, while allowing for special circumstances where a physician can override the decision and prescribe a brand-name drug.
The team also offered a caveat to their findings. They note that their results may actually underestimate just how common the practice of favoring brand-name pharmaceuticals over generic drugs might be. This, they say, is probably due in no small part to a social desirability bias in physician self-reporting.
Additionally, it is difficult to accurately estimate just how often the prescribed brand-name drug was actually dispensed by the pharmacy, as a number of states do allow the pharmacist to substitute a generic equivalent without the approval of the prescribing physician.
Study co-author Christine Vogeli of the MIHP adds: "Reducing or eliminating this practice represents low-hanging fruit in terms of reducing unnecessary spending in medicine. However, doing so will likely be unpopular with some patients, physicians and certainly with the drug industry."
Additional co-authors of the study included Genevieve Pham-Kanter, PhD, of the MIHP and the Safra Center for Ethics at Harvard University, and Lisa Iezzoni, MD, director of the MIHP. The current study and overall survey were supported by a grant from the Institute on Medicine as a Profession (CMAP)at Columbia University.