Vital Signs Blog

Blog: ACP urges docs to prescribe more generics

Doctors often prescribe expensive brand-name drugs even when generics would be cheaper and just as effective. Physicians should instead prescribe generics whenever possible, the American College of Physicians recommended this week.

U.S. spending on prescription drugs reached nearly $374 billion last year, and prescription drugs took up a 12.6% share of U.S. healthcare costs. Drug companies and their leaders are in the crosshairs, from the presidential campaign trail to healthcare industry boardrooms. But current scrutiny, inspired in part by the eye-popping costs of new drugs like Gilead Sciences' Sovaldi, which runs $84,000 for a course of treatment, appears to be focused on affecting pricing.

In a report published this week in the Annals of Internal Medicine, the American College of Physicians' Clinical Guidelines Committee suggests physicians can play a more direct role in lowering drug spending--by prescribing generic drugs more often.

"The use of generic drugs is a high-value-care way to improve health, avoid harms, and eliminate wasteful practices,” said Dr. Wayne Riley, president of the American College of Physicians, in a news release about the new guidelines. “ACP recognizes that there are situations where generic substitution is not possible and the use of brand name drugs is clinically appropriate,” Riley said, but the organization recommends use of generic drugs in all other situations.

Generics are bioequivalent copies of their brand-name counterparts, usually providing similar therapeutic benefits with a price tag that can be 30% or as much as 80% cheaper. Some studies have shown that patients are more likely to maintain medication adherence when their prescriptions are cheaper. The rate of drug abandonment, in which patients fill a prescription but never pick it up, is more than twice as high for brand name drugs as for generics, the ACP notes. One study reviewed by the panel found that brand-name drugs for which generic versions were available accounted for 23-45% of diabetic Medicare beneficiaries' prescriptions in 2008. Substituting generics for those patients alone would save Medicare $1.4 billion per year.

So why do docs keep prescribing brand-name medicines when generics have been shown to provide savings and promote better compliance? The problem could lie with physicians or patients, the committee said. "Because generic drugs are not required to be therapeutically (as opposed to biologically) equivalent to brand-name agents, some physicians and patients have expressed concern that generic medications are less effective or more dangerous than their brand-name counterparts," the authors wrote.

In one study reviewed by the committee, a quarter of physicians surveyed admitted to worrying about the safety of generics and did not want to use them for themselves or their families. In another, although the majority of Americans surveyed agreed that generics are good and cost effective, only a little more than a third of respondents preferred to use generics themselves. Many physicians say they prescribe brand-names to patients because that's what they request. (Last week, the American Medical Association came down in favor of a ban on direct-to-consumer drug marketing for that very reason.) And doctors who yield to patient requests are even more likely to prescribe the brand names when they've received meals, samples or gifts from drugmakers, a potential conflict-of-interest lawmakers sought to address in recent years with the passage of the Sunshine Act and launch of the CMS' Open Payments database.

The ACP committee says generic use could be boosted through awareness efforts akin to those used by brand-name drugs, such as academic detailing and providing physicians with samples for patients, or by providing decision support favoring generics in electronic health-record systems. The ACP recommends additional testing to determine whether those methods would boost generic prescribing.


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