Dispense As Written

Reuters recently reported on a new study put out by the American Journal of Medicine in which they post the following:

“Patients are less likely to fill prescriptions when their doctors specify that brand name drugs can’t be substituted with generics, according to a new study. Along with leaving patients without their medications, the practice could be costing the health system almost $8 billion a year, the authors of the study in the American Journal of Medicine calculated. (bit.ly/eZZjHh)”

First off, the article makes no attempt to educate readers as to whether generics are as effective as brand alternatives in all cases. This is a material factor as to whether a patient is going to be willing to opt for a generic drug option. Second, the underlying statistical math seems very loose. The study extrapolates a possible $8B a year savings from a 4% variance between prescriptions being filled when a generic option is given versus not. How they get to $8B in savings is as murky as it gets. The detail underlying the math is left vague and the implication is that physicians are the root cause of this bloated industry cost.

Moreover, they gloss over an odd finding in the study: “But even when patients were the ones who had requested a brand name drug, they were less likely to fill the prescription when they couldn’t substitute generics.” There was no attempt to explain this or how it factored into the math.

I asked Dr. Jeffrey Atkins of St. Louis about his thoughts on the issue. He responded:

“For the most part generic medications are worth a try. There are many categories of medications (hypertension and cholesterol for example) where the medications can be judged by specific tests/numbers – blood pressure readings and cholesterol numbers in these cases.

[However] physicians should insist on brand names for certain illnesses – for example, thyroid disease and seizure disorders. The reason is that there are many companies making generics, and the acceptable range of generics matching brands is too broad. Depending on the pharmacy, they may be switching generics every month.

The government, if they are going to address healthcare, needs to address medications. Stricter regulations are needed so that all generics are closer to the brand version. The problem is that it will cost more.”

I am certainly advocating against generics, but instead using articles like this to highlight the reports and fuzzy math that can lead to very poor personal and/or policy decisions.


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