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Should Doctors Be Paid to Prescribe Generic Drugs?
By JLP | January 24, 2008
From the front page of the Marketplace section of today’s Wall Street Journal:
Health plans are drawing scrutiny for offering financial incentives to entice doctors to prescribe cheaper generic medicines, including paying doctors $100 each time they switch a patient from a brand-name drug.
Pharmaceutical companies have long gone to great lengths to try to get doctors to prescribe their brand-name pills. They spend billions of dollars, plying physicians with samples, educational lunches and speaker fees. But as the patents for a growing number of blockbuster medicines expire, some health insurers are trying to trump those perks with bonuses or higher reimbursements for writing more generic prescriptions.
The idea, health plans say, is to save everyone — patients, employers and insurers — money. And many doctors argue that it’s only right to reimburse them for spending time evaluating whether a cheaper generic alternative is better or as good for a patient.
But the more aggressive approaches, such as cash rewards for each patient switched from a given list of drugs, are coming under fire for injecting financial incentives into what some patient advocates and legislators say should be a purely medical decision. Medical societies are also concerned that such rewards may put doctors in the ethically questionable position of taking a payment that patients know nothing about.
Source: Doctors Paid To Prescribe Generic Pills ($), Wall Street Journal
Call me crazy, but I don’t see what the big deal is. If a generic drug does the same thing as the higher-priced name-brand drug, what difference should it make to the patient which drug the doctor prescribes? Besides, haven’t the big drug makers been doing essentially the same thing as the health insurers by giving gifts and perks to the doctors? The drug companies aren’t doing this out of the goodness of their hearts. They’re doing it to sell more drugs. Now the insurance companies are fighting back.
Some people are calling these payments unethical. I would say that they’re only unethical if the generic drug is inferior to the name-brand drug. Right?
Bottom line: I’m for anything that will lower the price of healthcare.
Topics: Insurance | 12 Comments »
January 24th, 2008 at 10:29 am
I think from the employment quadrant doctors should not be paid .I think all pharmaceuticals across america would go up in price as well as health insurance. Plus doctors make enough already.
http://www.livelymoney.blogspot.com/
January 24th, 2008 at 12:36 pm
You’re right – the brand-name drug companies do the same thing, why should it be any different for generic drug companies? Generics are EXACTLY the same thing as their brand-name competitors (minus the brand name logo). They only come out when the patent on the drug has run out.
January 24th, 2008 at 12:49 pm
I don’t see a problem.
However the better solution is to pay the patient when they switch from a brand-name to generic.
January 24th, 2008 at 3:27 pm
Oh this explains my confusing doctor’s appointment I had! I have been on a medicine for 5 years now that does not yet have a generic alternative. It took years previously to find a medicine that I could tolerate, so I have tried many in the same class.
I recently moved, and my new doctor was bending over backwards to get me off that medicine and onto a different, generic drug (different active ingredient, but in the same class). He was claiming it would save me money, but my insurance has the same co-pay no matter the drug. I had to explain over and over again that I’d tried the other drugs (looking at the active ingredients here) and the non-generic one I’m on was the only one I could use. He would only write me a prescription for the generic ones, despite my previous bad reactions to them.
Maybe he was getting kick-backs from the insurance company?! I’ll just ask him next time I go.
January 24th, 2008 at 11:08 pm
Physicians are already paid massive amounts by the name-brand drug companies. All-expenses-paid vacations pretending to be continuing education, expensive meals at fine restaurants disguised as inservices, ads all over the “free” office supplies, and so on. So I think Big Pharma is just annoyed that the generics manufacturers want in on the party.
January 25th, 2008 at 1:06 am
I am a primary care physician and would like to give another perspective. Cash incentives to get patients to move from ANY drug to ANY other really does muddy the picture when it come to prescriber (and patient choice). For what it’s worth, the days of trips, theater tickets and the extravagant giveaways to doctors for pitching medications are long gone. Pens and pads and the “moderately priced meal” (usually a take-out lunch at the office) are the norm. At the same time, PHARMA is spending the big bucks on direct to consumer advertising.
For the most part, new medications do not add much over older, generic medications. I prescribe them whenever possible because there is no reason to use “latest and greatest” medications when medications with proven track records are available at a much lower cost. Sometimes a new medication is more potent or better tolerated and is a wise move (or a backup option). Mostly, generic medications are just fine and far more cost effective. But taking a payment from an insurance provider for changing to cheaper medication to me would be exactly as unethical as taking a payment from a drug company to write for an expensive one. My priority is to the person I am treating, and an honest partnership between patients and their doctor is essential. If the thought that I (or my doctor) was motivated to write (or not write) for a drug for ANY reason other than being the best medical decision, then seek care elsewhere.
January 25th, 2008 at 8:24 am
Care needs to be taken is using the generic name “generic” when refering to Rx drugs. I can only speak for Texas since that is the state in whic I live and do business. In the Rx world, we are an Orange Book state. My understanding of that is “generic” drugs are the same as Name Brand drugs (however, I know of one that is capsule instead of tablet)which means the outcome is exactly the same. The next level is “generic equivalent” drugs. These are supposed to have the same outcome and active ingredient, but the binders coloring, and fillers can differ from the Name brand drug. In a non-Orange Book state it is my inderstandint that the “generic equivalent can be marketed as “generic”. I believe I am correct on this, but if anyone has more up to date facts, please correct me.
I do believe that a patient has the responsibility to make sure a particular drug will work correctly for them. When helping my clients choose their medical insurance carrier, a large consideration is given to a Rx plan that allows the formulary drug (preferred name brand, lower co pay) to be the drug with the best overall clinical results instead of the cheaper of the name brand drugs, with an option for a “generic” if available.
Scott
January 25th, 2008 at 12:55 pm
First of all Generic Pharmaceuticals and Branded Pharmaceuticals are not equally the same. A generic prescription has to receive an ANDA (Abbreviated New Drug Application) from the FDA, under an ANDA a generic has the right to have its active ingredients vary plus or minus 10%. This is why very few prescriptions are written for Levothyroxine the Generic to Synthoid due to the NTI (Narrow Therapeutic Index) since the active ingredients in these products are measured in micrograms. Furthermore, year after year, Levothyroxine is the number one medication written by internal medicine doctors and endocrinologists due to increases in hypothyroidism. No other medication is written more. Finally, Generics do not have to have the same inactive ingredients in their products that the original branded product had. This can lead to some problems for patients who might have a hypersensitivity to some inactive fillers. These two statements are commonly known in the medical profession.
January 26th, 2008 at 3:36 pm
Most pharmacists automatically fill a prescrition with a generic unless the doctor writes “Dispense as Written” on the script. I understand the article to read that the doctor is being paid to write a script for a generic instead of a different drug where there is not yet a generic available. So is the doctor writing this generic based on what is in the patient’s best interest or because he is being paid $100 to not write a script for a potentially better, more effective medicine. Is the doctor liable if the patient does not get better because he used a less effective medicine? Will healthcare suffer? Who knows? Is he violating the hipocratic oath?
February 7th, 2008 at 4:10 pm
Adding to Jason’s comment… according to my doc, generics are often NOT exactly the same as branded drugs. They contain the exact same ingredients, but they may not be processed the same way – which can lead to changes which affect efficacy. Some work exactly the same and some do not. Docs shouldn’t get kickbacks for the ’scripts they write from anyone (insurance companies or drug companies), in my opinion… it’s a conflict of interest.
Jerry
http://www.leads4insurance.com
January 7th, 2009 at 2:42 pm
It should be illegal for drug companies to compensate physicians for pushing brand name drugs and driving up health care costs. I am currently seeking a new pain management physician as my current doctor continues to refuse to prescribe cheap and effective generic medications in favor of patented drugs–most recently Avinza. I was taking two 15mg generic long-acting morphine pills daily with little success. She switched me to Opana (roughly $110 for a one month supply) which made me sick without controlling my pain. After ignoring my complaints for three weeks, she put me on a single 30mg Avinza daily. Avinza is a brand name long-acting morphine sulfate formulation; the generic version cost $10 for a one month supply while Avinza set me back $130 for thirty pills. I wonder how much the makers of Avinza and Opana pay my corrupt physician (Dr. Rowena Mariano) in “consulting” fees.
March 5th, 2009 at 5:06 pm
Well, I have some first-hand knowledge of this. Generics AREN’T the same. The chemicals might be the same but the process isn’t necessarily the same. The insurance companies certainly won’t tell you this but I have taken a generic on more than one occasion that did not work as it was indicated. I had to finally go back the name brand (at MY expense) and use it. I’m not sure how I feel about the doctors, though. I think it might lead to a conflict of interest.
Jerry
http://www.leads4insurance.com