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Using generics supports High Value Care, can help to reduce
$325 billion spent annually in U.S. on prescription drugs
Philadelphia, November 24, 2015 -- All clinicians should
prescribe generic medications whenever possible as a way to improve
adherence to therapy and clinical outcomes while containing costs,
American College of Physicians (ACP) advises in a new paper
published today in Annals of Internal Medicine.
"While the use of generic drugs has increased over time,
clinicians often prescribe more expensive brand name drugs when
equally effective, well proven, and less expensive generic versions
are available," said ACP President Wayne J. Riley, MD, MPH, MBA,
MACP. "The use of generic drugs is a High Value Care way to improve
health, avoid harms, and eliminate wasteful practices."
In the paper, ACP looked at how often brand name drugs are used
when generic versions are available, how the use of generics
influences adherence, whether brand names and generics have similar
clinical effects, the barriers to increasing the use of generics,
and strategies that can be used to promote greater use of
A study of Medicare beneficiaries with diabetes found that the
use of brand name drugs for which identical generics are available
accounted for 23% to 45% of prescriptions, depending on the class.
The study authors estimated that Medicare could save $1.4 billion
for patients with diabetes alone by combing generic substitution
and therapeutic interchange (dispensing medications that are
chemically different but therapeutically similar).
The greater use of generic drugs could motivate better long-term
adherence to essential therapies. Higher out-of-pocket costs for
patients have consistently been associated with lower rates of
long-term medication adherence. Prescriptions for branded drugs are
almost twice as likely to be "abandoned" (i.e., never picked up
after being filled) than generics.
The vast majority of the peer-reviewed evidence has found that
generic drugs are as effective as their branded counterparts
regarding clinical outcomes. In contrast to the data for other
therapeutic classes, some evidence suggests a lack of equivalence
of brand and generic ophthalmic agents.
"ACP recognizes that there are situations where generic
substitution is not possible and the use of brand name drugs is
clinically appropriate," Dr. Riley said.
Some of the underuse of generic medications is likely the result
of patient and physician perceptions about the safety and a
perceived lack of efficacy of the lower cost options. Patients may
also associate the lower price of generics with lower levels of
Differences in the physical appearance of generics and their
brand name counterparts might also cause confusion among patient.
Variations in pill appearance have been associated with higher
rates of non-adherence.
To promote greater generic medication use, adoption of
electronic medical records could support generic prescribing
through the notification of the formulary status of prescribed
medications. Use of interactive forms of continuing medical
education, such as academic detailing, are effective methods of
changing physician behavior, and therefore could promote generic
prescribing. When combined with academic detailing, a randomized
trial that provided vouchers to physicians for use by their
patients switching to or initiating a generic found a statistically
significant 2% increase in generic prescribing as compared to
academic detailing alone.
Because the receipt of branded drug samples appears to be
associated with the greater prescribing of brand name products,
providing physicians with free samples of generics to provide to
their patients could increase the use of generic medications.
Public awareness and advertising campaigns similar to those used
for brand name drugs might help to alter patient perceptions about
generics. Policy levers, like tiered formularies, have been the
most effective strategies for driving patients to adopt generics,
but current copayment differentials between generic and brand name
medications may not be sufficient to motivate generic drug use by
About the American College of Physicians
The American College of Physicians is the largest
medical specialty organization and the second-largest physician
group in the United States. ACP members include 143,000 internal
medicine physicians (internists), related subspecialists, and
medical students. Internal medicine physicians are specialists who
apply scientific knowledge and clinical expertise to the diagnosis,
treatment, and compassionate care of adults across the spectrum
from health to complex illness. Follow ACP on Twitter and Facebook.