In a new report, the American College of Physicians call for all doctors to prescribe generic medications over brand-name drugs, where possible, in order to improve treatment adherence and reduce health care spending.
Conducted by members of the American College of Physicians’ (ACP) Clinical Guidelines Committee, the report is published in the Annals of Internal Medicine.
While the use of generic drugs has increased over time, the authors say that many health care providers continue to prescribe expensive brand-name drugs when cheaper generic alternatives are available – an issue that is likely to contributing to high health care costs; around $325 billion is spent on prescription drugs each year in the US.
By reviewing around 2,500 studies of prescription practices, the ACP assessed how often doctors prescribed brand-name drugs when generic alternatives were available.
The Committee also looked at how the prescription of generic medications affects treatment adherence, whether brand name and generic drugs produce similar clinical effects, what the barriers are to increasing use of generic medications and what can be done to overcome such barriers.
“The purpose of this article is to help guide internists and other clinicians in making high-value, cost-conscious decisions about the use of generic drugs,” the authors explain.
On assessing the frequency of brand-name drug prescription, the authors found that – as expected – health care providers often prescribe brand-name drugs over the generic equivalents.
- Around 48.7% of Americans have used at least one prescription drug in the past 30 days
- More than 10% of Americans have used five or more prescription drugs in the past 30 days
- In 2010, more than 75% of doctor’s visits results in a drug prescription.
The authors estimated that for Medicare beneficiaries with diabetes alone, substituting brand-name prescription drugs for generic alternatives combined with therapeutic interchange – prescribing drugs that are chemically different but therapeutically similar – would save $1.4 billion.
The majority of peer-reviewed studies found that generic equivalents to brand-name drugs produced similar clinical outcomes, according to the authors, despite some physicians expressing concern that generic medications are less effective or cause more severe side effects.
“For example, a meta-analysis of 47 studies compared the effectiveness of generic and brand-name drugs in nine classes of cardiovascular medications and found no evidence of superiority of brand-name medication, including among anticoagulants and antiarrhythmics with narrow therapeutic windows,” they explain.
However, the ACP admit there are some situations where a brand-name drug may be more clinically appropriate than its generic alternative, or cases where prescribing an alternative is not possible.
The authors found that long-term adherence to treatment could be improved with increased prescription of generic medications, noting that prescriptions for branded medications are almost twice as likely to go uncollected after being filled than generic medications.
This is likely because brand-name drugs are significantly more costly than generic medications, though the authors note that the price of generic medications has been increasing recently.
Based on the findings of the report, ACP President Dr. Wayne J. Riley says:
“The use of generic drugs is a High Value Care way to improve health, avoid harms, and eliminate wasteful practices.”
The authors cite a national survey that found, while most patients believed generic drugs were cheaper and better value than brand-name drugs, only 36% of Americans said they preferred to use them.
They believe the underuse of generic drugs is likely fueled by patient concerns about their safety and efficacy, with many believing that because they are cheaper, they will be less effective.
“Differences in the physical appearance of molecularly identical generics and between generics and their brand-name counterparts could also influence patient perceptions of efficacy or safety; such variations in pill appearance have been associated with higher rates of nonadherence,” say the authors.
Physicians are also concerned about the safety and efficacy of generic medications, according to the report, with one survey finding that around a quarter of doctors preferred that themselves and their family did not use them. Such a perception means that many doctors are unlikely to prescribe generic medications to patients.
Given the improved treatment adherence and cost savings associated with use of generic medications over brand-name drugs, the ACP concludes:
“Clinicians should prescribe generic medications, if possible, rather than more expensive brand-name medications.”
As such, the organization recommends a number of strategies to help increase prescription of generic drugs over brand-name drugs.
The authors suggest generic prescribing could be boosted through the uptake of electronic medical records, which will inform health care providers of the “formulary status of prescribed medications, as will be required by the ‘meaningful use’ criteria of the Affordable Care Act.”
Physician behavior could be altered through continued interactive education, such as academic detailing, according to the authors, who note that this could better inform doctors about the safety and efficacy of generic medications.
In addition, they suggest generic medications should be subject to similar public awareness and advertising campaigns as branded drugs; this may help change patient perception toward generic drugs.
Policy levers, such as tiered formularies – health plans incorporating lists of generic and brand-name drugs divided into groups based on cost and effectiveness – have proven effective for increasing use of generic medications, the authors note.
However, they point out that “current copayment differentials between generic and brand-name medications may not be sufficient to motivate generic drug use by some patients; thus, a need for further research about these behavior change tools also remains.”
Medical News Today recently reported on a study published in the American Journal of Public Health that found public health spending has fallen 9.3% since 2008.