January 16, 2013
Why Do Prescribers Opt for Brand Name Drugs When Generics Are Available? Survey Offers Some Clues

Boston—Pharmacists may be puzzled when asked to dispense brand-name medications even though less-expensive generic substitutes are available. Now, a new survey provides information on why that might occur.

In an online article from JAMA Internal Medicine, authors discuss the results of a survey of 1,891 randomly sampled physicians about their prescribing habits related to brand-name versus generic drugs. According to the survey, about 4 of 10 physicians sometimes or often prescribe the brand-name medication when a generic is available, usually at the patient's request.

The survey from the Mongan Institute for Health Policy at Massachusetts General Hospital also revealed that physicians who received industry-provided food or beverages in the workplace and samples, as well as physicians who met with industry representatives to stay up to date, were more likely to prescribe brand-name medications to patients who ask.

Authors suggest that part of the solution to the problem is to give pharmacists a bigger role in the process.

“The good news is that 63% 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% or about 286,000 physicians nationally—do meet those requests,” suggests lead author Eric G. Campbell, PhD, a professor of medicine at Harvard Medical School. “Since generics are from 30 to 80 percent cheaper than the brand-name versions, that would represent a significant source of unnecessary health costs.”

Almost 1,900 out of 3,500 physicians responded to the 2009 survey of medical professionalism. The survey was originally sent to 500 physicians in each of seven specialties: internal medicine, family practice, pediatrics, cardiology, general surgery, psychiatry, and anesthesia.

Patient requests for brand-name drugs were more often granted by physicians who had been in practice more than 30 years and those in solo or two-person practices, the survey found. Among specialties, those requests were honored most often in internal medicine and psychiatry settings.

The survey also indicated an association between prescribing brand-name drugs and benefiting from pharmaceutical marketing activities such as receiving industry-sponsored food or beverages in the workplace and receiving free drug samples. No association was seen with industry-paid speaking or consulting or with receiving industry gifts or reimbursement of travel expenses.

“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,” Campbell pointed out. “Our results also raise serious doubts about the desirability of meeting with drug company representatives to 'stay up to date'.”

Interestingly, one solution suggested in the report is for hospitals and health systems to require that drug samples go through their pharmacies instead of directly to physicians or to leave the decision to prescribe a brand-name or generic drug to pharmacists. The authors point out that a similar system is used by the U.S. Veteran's Health Administration, which only allows physicians to insist on a brand name in special circumstances.

In addition, they call for more patient education about pharmaceutical marketing activities. “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,” added study co-author Christine Vogeli, PhD.

U.S. Pharmacist Social Connect