The difference between brand-name pharmaceutical drugs and their generic counterparts, says Eric Campbell, is not the same as the difference between brand-name and generic, say, mac and cheese.
"The generic mac and cheese doesn't have any requirements that it be the same, or that it be anywhere near as good [as the brand-name]," he said. "Drugs are required to be the same."
Campbell, a professor of medicine at Harvard Medical School, is comparing drugs to the cheesy snack because he led a study that looked at how often doctors prescribe pricey brand-name drugs, even though generic drugs are much cheaper and are legally required to "have the same active ingredient, strength, dosage form and route of administration as the brand name."
What he found troubled him. The research, which appeared in the journal JAMA Internal Medicine, shows that 37 percent of doctors surveyed admitted to "sometimes or often" prescribing a brand-name drug when an equivalent generic was available because the patient asked for the brand-name version specifically.
It also found that doctors who accepted small gifts from drug companies – like samples, food or drinks – were "significantly more likely to accede to patient demands for brand-name drugs." The same was true of doctors who had what Campbell called "informational meetings" with drug representatives, which are theoretically meant to keep physicians up-to-date on pharmaceutical industry happenings.
The problem with brand-name drugs
That's not a good trend, Campbell said, because when it comes to brand-name drugs, only the drug companies win. The patients, on the other hand, are the losers.
"Brand-name drugs are by and large, especially over time, equivalent to generics," he said. "But the brand-name drugs cost a heck of a lot more."
Between 30 and 80 percent more, to be precise. Campbell said those costs are borne by the patients – whether it's out-of-pocket, through higher co-pays or higher insurance premiums.
Consumer Reports compared the price of a few brand-name drugs to their generic equivalents:
– For diabetes: Brand name, up to $84 per month; generic substitute, up to $8 per month.
– For heart failure: Brand name, up to $166 per month; generic substitute, up to $44 per month.
– High cholesterol: Brand name, up to $175 per month; generic substitute, up to $70 per month.
– Migraine headaches: Brand name, up to $78 per month; generic substitute, up to $48 per month.
Those sorts of disparities may help illustrate the Food and Drug Administration's claim that in 2010, the use of approved generic drugs resulted in savings of about $158 billion – or about $3 billion a week.
The drug companies, for their part, "make their best margins on brand-name drugs," said Campbell.
What it means for the uninsured
The prescribing of brand names when there's a generic version available is bad news for those without insurance. If someone who is uninsured asks for a brand-name drug – say, because he or she has seen it in a commercial – and the doctor agrees to prescribe it, that person will pay up to 80 percent more than they would have if she or he had gone the generic route.
That's usually not financially sustainable, which could have serious medical consequences.
"Among this population, it's more likely to lead to a lack of compliance in taking their drugs," said Campbell.
The core of this problem, he said, is that "by and large drug companies are for-profit." They advertise – aggressively – and incentivize doctors with freebies to get their products into patients' hands.
"I'm not saying drug companies are bad," said Campbell. "We don't blame drug companies for charging a lot of money for new drugs. Because that's what they do. That's the system we've created."
He said there's also a lack of education among doctors and patients about the implications of using pricey brand-name medications.
"We haven't structured our health care system in a way that makes it so that doctors have the time, skills and motivation to talk to patients who are requesting brand-name drugs to explain why the patients don't really need those," said Campbell.
In the study, he and his colleagues write that a system "that gives the pharmacy primary control over" when brand-name drugs are prescribed could help stem the prescribing of overpriced medication when there are generic options available.
"Also, hospitals and health systems could consider policies that prevent individual physicians from receiving samples [from pharmaceutical vendors] and instead require samples be given to a pharmacy or other appropriate office in a hospital or health system," wrote the study's authors. They also suggest that payers like Medicare consider banning doctors from accepting freebies in the workplace.
"We need to cut the marketing to physicians if we really want to deal with this," Campbell said.
Photo by arbyreed via Flickr Creative Commons.