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January 08, 2013 8:32 AM Physicians and Brand Name Drugs

By Aaron Carroll

I’ve often put forth my belief that one easy way we could reduce spending is to stop paying for things that don’t work, or more for things that don’t work any better than cheaper alternatives. One easy way to start would be to pay no more than for generics when such drugs are available. Yet many physicians prescribe more expensive name brand drugs even when generics are available. A recent study examined why. “Physician Acquiescence to Patient Demands for Brand-Name Drugs: Results of a National Survey of Physicians“:

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. Pharmaceutical companies aim to stimulate patients’ requests for brand-name medications and increase the likelihood physicians will honor such requests. Presently, little is known about how frequently physicians comply with such a request or the factors predicting this behavior.

This was a national survey of 1891 physicians in 7 specialties asking why they prescribed name brand alternatives over generics. Here’s what they found:

The multivariable regression shows that 43% of physicians in practice more than 30 years sometimes or often give in to patients’ demands for brand-name drugs compared with 31% physicians in practice for 10 years or less (P = .001)…
Two specific forms of industry relationships were associated with significant differences in the percentage of physicians who acquiesced to patient demands. More than a third who received free food and/or beverages in the workplace honored patient requests sometimes or often compared with those who had not received food and beverages (39% vs 33%; P = .003). Similar significant differences were found among those receiving drug samples (40% vs 31%; P = .005). Also, physicians who sometimes or often met with industry representatives to stay up to date were significantly more likely to comply with patients’ demands than those who did not (40% vs 34%;P = .007).

Industry practices exist for a reason; it’s cause they work. Many physicians discount the free food at lunches as harmless, but such lunches are associated with prescribing name brand drugs. So are receiving free samples and meeting with representatives. Ignoring this evidence is fooling ourselves.

Once again, this is an easy way to save money, with almost no implications in terms of quality. I think it’s fine to spend your own money to get name brand drugs over generic equivalents. It&88217;s hard to justify spending other people’s money for the privilege.

[Cross-posted at The Incidental Economist]

Aaron Carroll ,MD, is an associate professor of Pediatrics and the associate director of Children’s Health Services Research at Indiana University School of Medicine.
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