When drug ads tell consumers to ask their doctor if Drug X is right for them, it often leads to patients getting a prescription for that drug, according to an online-first research letter
posted by JAMA Internal Medicine (formerly the Archives of Internal Medicine).
Researchers from Harvard Medical School and the Colorado School of Public Health found that 37% of the almost 1,900 randomly selected physicians they surveyed reported sometimes or often prescribing the specific drug a patient wants over an available generic option.
"Prescribing brand-name drugs when generic drugs are available generates unnecessary medical expenditures, the costs of which are borne by the public in the form of higher copayments, increased health insurance costs, and higher Medicare and Medicaid expenses," the authors wrote. "These numbers suggest that the unnecessary costs associated with this practice to the healthcare system could be substantial."
Seniority played a role, as 43% of physicians in practice for more than 30 years said they sometimes or often prescribe brand-name drugs when generics are available, compared with 31% of doctors in practice for 10 years or fewer. Among the seven specialties covered by the survey, 50% of internists and psychiatrists said they sometimes or often prescribe brand-name drugs over generics when patients request them, compared with 17% of pediatricians and 20% of general surgeons. Also, 46% of physicians in a solo or two-person practice said they sometimes or often prescribe brand names over generics when requested, compared with 35% of those who work in a hospital or medical school.
Gender made a small difference, as 39% of female doctors reported that they sometimes or often prescribe brand-name drugs over generics for patients upon request, while 37% of male physicians surveyed reported doing so. Among doctors receiving pharmaceutical industry gifts of food and beverages in the workplace coinciding with "up-to-date" or "detailing" meetings with drug company representatives, 39% said they sometimes or often prescribe the brand-name version over the generic if a patient requests it. In comparison, 33% of physicians said they don't accept free food in the workplace.
Dr. Patrick O'Malley, deputy editor of JAMA Internal Medicine, wrote in an accompanying editorial
that "systems-level interventions" are needed—such as managed formularies with physician-override capabilities—to overcome these "irrational cultural practices."
"For unclear reasons, a large proportion of physicians are reluctant to opt for the more cost-effective choices, especially if patients request brand-name drugs," O'Malley wrote, noting that there is an "immense cost" associated with prescribing brand-name drugs when generics are an option.
The study was paid for with a grant from Columbia University's Institute on Medical Professionalism.