Why Are Physicians Still Prescribing High Cost Brand Name Drugs? Ask Pharma.
Troyen Brennan, M.D. is Executive Vice President and Chief Medical Officer of CVS Health, a pharmacy innovation company.
Generic drugs are a boon in health care. Typically lower in cost and as effective as their branded counterparts, they help control pharmacy spending and increase access to important therapies for patients who could be deterred by the high cost of some branded drugs. In fact, research shows that the use of generic drugs produces annual savings in excess of $200 billion.
Why, then, are some physicians still prescribing the higher cost, branded versions of these drugs?
The devil may be in the “detailing.” Pharmaceutical detailing – a common marketing practice whereby physicians receive sales visits from pharmaceutical reps – is pervasive and can keep certain drugs top-of-mind for physicians, influencing their prescribing behavior.
This point was underscored by new research recently published in the Journal of the American Medical Association (JAMA) for which CVS Health provided de-identified pharmacy claims data. The study examined the impact of policies limiting pharmaceutical detailing at academic medical centers. When these policies were implemented there was an increase in prescribing of “non-detailed” drugs, more than 95 percent of which were generics.
Plainly stated, when prescribers were visited by pharmaceutical sales reps less often, they prescribed generic medications more often. In fact, the overuse of high cost brand name medications resulted in about $73 billion in costs to the U.S. health care system between 2010-2012, about a third of which was paid for by patients.
Pharmaceutical marketing is ubiquitous as manufacturers seek to recoup the costs associated with research and development (R&D) and turn a profit. But manufacturers’ sales and marketing activities are now outpacing R&D costs, and spending on certain kinds of marketing practices such as direct-to-consumer advertising has nearly doubled since 2013.
Pharmaceutical detailing activities are the most common direct-to-physician marketing practice and are often the primary interaction that doctors have with drug manufacturers, who rely on detailing to increase prescribing of their drugs. While detailing serves a purpose to educate physicians about drugs and their benefits, this research clearly shows that detailing can also lead to increased prescribing of these drugs, which are often higher cost, brand name drugs, with lower cost, just-as-effective, generic alternatives available.
This new research clearly underscores the need for continued monitoring and increased scrutiny of pharmaceutical marketing practices. But beyond what manufacturers are doing to increase sales of certain drugs, physicians should also consider the cost of drugs when making prescribing decisions. This is especially important as the high cost of prescription drugs and pharmacy care continue to dominate the national health care debate.
One way to do that is to give physicians better visibility into the cost of prescription drugs at the moment they are being prescribed. This can be done through enhanced e-prescribing and connectivity with electronic health records. These tools help physicians view their patients’ insurance information in real time, find lower cost drug options, including lower cost generics, and also help initiate and expedite prior authorization requests, when needed. As a result, physicians can understand their patients’ out-of-pocket drug costs and can take that into account when making any prescribing decisions. Pharmacy benefit managers, working with electronic medical record vendors, are now testing such programs.
In addition, in plans with high deductibles, the pharmacy benefit manager can make it possible for patients to have access to preventive medications, sometimes with zero co-pay, before they meet their deductible. As these high deductible plans become more prevalent, such preventive drug lists will be critical to ensuring that patients can have access to their medications.
Finally, the government also has an important role in helping to increase drug competition, which can drive down drug costs. For example, addressing the backlog of generic medicines awaiting FDA approval and promoting policies that do not delay market entry of generic drugs will help increase the number of lower cost generic drugs available in the marketplace.
The new research underlines the fact that pharmaceutical manufacturers have a strong financial incentive to get people to take high priced medications. But today, neither the health care system nor the patient can afford unnecessary costs when equally effective, less expensive generic medications are available.