Docs, and patients, should remember to use generics

Prescribing generic medicines instead of brand name drugs whenever possible cuts costs, improves patient adherence and improves health outcomes, according to a new recommendation from the American College of Physicians.

"Generic medications are cheaper and patients are more likely to get those prescriptions filled," said Dr. Amir Qaseem of the American College of Physicians, who coauthored the recommendation.

"This is for both physicians and patients," Qaseem told Reuters Health by phone.

Despite what some patients and even doctors may believe, generics are consistently as effective and safe as their brand-name counterparts, he said.

The ACP reviewed existing evidence and found that for Medicare beneficiaries with diabetes, for example, up to 45 percent of prescriptions are for brand-name drugs when identical generics are available. Choosing these generics instead, and choosing therapeutically similar but chemically different generics in some other cases, could save up to $1.4 billion for Medicare, the reviewers found.

Brand name prescriptions are almost twice as likely to be prescribed but never picked up from the pharmacy than generics, and not adhering to prescribed medications leads to higher out-of-pocket costs for patients later on, the reviewers wrote in the Annals of Internal Medicine.

"Often, patients don't tell their doctors they can't afford an expensive drug they were prescribed; they just fail to take it, or take it at sub-therapeutic (too low) doses because of its cost," said Dr. Jerome Avorn, professor of medicine at Harvard Medical School in Boston, who was not part of the new study. "And this has major health effects."

"Logically it might feel like people should already be using (generics), but that's not the case," Qaseem said.

The new recommendation "is based on a thorough review of data from a huge number of relevant studies in the medical literature, raising it above the level of 'conventional wisdom,'" Avorn said.

The American College of Physicians is one of the most widely respected bodies in medicine, Avorn told Reuters Health by email.

Some physicians may not be aware that a generic form of a medication is available, or may refer to the drug by its brand name out of habit, which results in more expensive prescriptions, Qaseem said.

Continuing physician education programs could keep doctors abreast of available generics, as well as interactive options on electronic health records, he said.

"A large scale public awareness campaign is what's needed," he said. "Many think if it's cheaper it's not as good."

But, there are some cases when a generic substitution is not available or is not appropriate for a particular patient, he noted.

"This information about generics is especially timely now, given all we've seen in the last year or two demonstrating that brand-name companies can charge whatever they please for their products, even if the price is astronomical," Avorn said. "It's not clear that will change any time soon, making it even more important to educate doctors to use generics whenever possible."