Going Generic is the Rx for Less Drug Spending

The debate over brand name versus generic drugs rekindled last month with a new report published in the Annals of Internal Medicine. The members of the American College of Physicians Clinical Guidelines Committee recommended: “Clinicians should prescribe generic medications, if possible, rather than more expensive brand-name medications.”

The group reviewed prescription practices to dissect the $325 billion spent on prescription drugs in the U.S. each year. Use of generic drugs has increased over time, the authors said, but many providers continue to prescribe expensive brand-name drugs when cheaper generic alternatives are available. Another study done this fall by ProPublica and the website Iodine measured similar levels of patient satisfaction with brand name and generic drugs.

“Generic medications are manufactured to be equivalent in all ways (except appearances) to brand-name medications,” said Joseph Ross, MD, a health policy researcher at Yale University School of Medicine. “Unfortunately, many patients and physicians are convinced to spend more and use the brand-name medication by marketing initiatives.”

Some physicians do express concern that generic medications are less effective or cause more severe side effects than brand-name drugs, but the majority of the peer-reviewed studies found similar clinical outcomes from the generic equivalents.

The new report includes several recommendations to increase prescription of generic drugs:

EMR: The uptake of electronic medical records, as required under Meaningful Use, will inform health care providers of the “formulary status of prescribed medications.” Generic medications are much more likely to require lower co-pays.

Public awareness: Advertising campaigns and other public awareness efforts for generic medications could also help change public perception toward generic drugs

Tiered formularies: The system of charging lower co-pays for generic and brand name drugs has proven effective for increasing use of generic medications.

Step therapy: The practice of encouraging the most cost-effective, and often safest, drug before progressing, if needed, to costlier or riskier therapy. State lawmakers in North Carolina and Ohio recently introduced legislation that would address step therapy, offering exemptions from step therapy protocol on some cases.

In my opinion, in the urgent care setting there’s very little benefit to prescribing brand name drugs. The high cost of brand name drugs discourages some patients from filling their prescription, thus actually threatening patient care.

Although it’s not a perfect system, generic drugs are required to show equivalence. Patients will see little, if any, of the purported benefits of brand name drugs. Of course, there might be a few drugs, such as thyroid hormones and warfarin, that have such narrow therapeutic windows that patients may benefit from receiving the exact same medication from the exact same manufacturer on a long-term basis.

However, in urgent care prescriptions are generally for the short term and generally involve medications with large therapeutic windows. Thus, physicians can prescribe generic medicines with a clear conscience as it accomplishes what is best for the cost of health care and what is best for the patient—and that is what is most important.