What's in a name? Use of brand versus generic drug names in United States outpatient practice.
ABSTRACT The use of brand rather than generic names for medications can increase health care costs. However, little is known at a national level about how often physicians refer to drugs using their brand or generic names.
To evaluate how often physicians refer to drugs using brand or generic terminology.
We used data from the 2003 National Ambulatory Medical Care Survey (NAMCS), a nationally representative survey of 25,288 community-based outpatient visits in the United States. After each visit, patient medications were recorded on a survey encounter form by the treating physician or transcribed from office notes.
Our main outcome measure was the frequency with which medications were recorded on the encounter form using their brand or generic names.
For 20 commonly used drugs, the median frequency of brand name use was 98% (interquartile range, 81-100%). Among 12 medications with no generic competition at the time of the survey, the median frequency of brand name use was 100% (range 92-100%). Among 8 medications with generic competition at the time of the survey ("multisource" drugs), the median frequency of brand name use was 79% (range 0-98%; P < .001 for difference between drugs with and without generic competition).
Physicians refer to most medications by their brand names, including drugs with generic formulations. This may lead to higher health care costs by promoting the use of brand-name products when generic alternatives are available.
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ABSTRACT: Generic substitution is one mechanism of curtailing prescription drug expenditures. Limited information is available about the potential savings associated with generic substitution. To estimate the potential savings associated with broad substitution of generic drugs. Cross-sectional, nationally representative survey of noninstitutionalized adults. United States. Adults included in the Medical Expenditure Panel Survey Household Component, 1997-2000. Use of a multisource drug (that is, a drug available in a brand-name and > or =1 generic formulation) or a generic drug and the potential cost savings associated with broad generic substitution for all multisource products. Fifty-six percent of all outpatient drugs were multisource products, accounting for 41% of total outpatient drug expenditures. Of these multisource drugs, 61% were dispensed as a generic. If a generic had been substituted for all corresponding brand-name outpatient drugs in 2000, the median annual savings in drug expenditures per person would have been 45.89 dollars (interquartile range, 10.35 dollars to 158.06) for adults younger than 65 years of age and 78.05 dollars (interquartile range, 19.94 dollars to 241.72 dollars) for adults at least 65 years of age. In these age groups, the national savings would have been 5.9 billion dollars (95% CI, 5.5 billion dollars to 6.2 billion dollars) and 2.9 billion dollars (CI, 2.6 billion dollars to 3.1 billion dollars), respectively, representing approximately 11% of drug expenditures. Specific information about an individual's formulary was not available, so the authors could not estimate how much of the potential savings would benefit an individual or his or her health plan. Although broad substitution of generic drugs would affect only a modest percentage of drug expenditures, it could result in substantial absolute savings.Annals of internal medicine 07/2005; 142(11):891-7. · 13.98 Impact Factor
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ABSTRACT: Drugs are marketed with generic and trade names. Our purpose was to study whether this dual name system causes problems to physicians. We interviewed 102 Finnish physicians to find out how well they recalled the composition of combination drugs, and connected the corresponding generic and trade names. The generic name of the given trade-names were known on average by 83% of the physicians who had recently prescribed them, but knowledge of the combination drugs was poor. When generic names were given, on average 9% of the physicians who had prescribed them could mention the corresponding trade names. A multitude of names causes information problems, with possible clinical consequences. From the information point of view, one naming system would be desirable.Scandinavian Journal of Primary Health Care 06/1984; 2(2):84-7. · 1.91 Impact Factor
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ABSTRACT: A survey of a national sample of family physicians was undertaken to investigate several aspects of attitudes and prescribing patterns related to generic drugs. Questionnaires were returned by 317 of 501 eligible respondents for a response rate of 63.3 percent. Of the respondents, 62.5 percent said they had enough confidence in generic drugs to prescribe them in their practices, but only 26.9 percent said they actually prescribed mostly generics. Respondents were also asked to indicate the relative importance of several potential sources of information on new drugs and to test their ability to recognize a list of generic and trade name drugs. Several associations were identified between physicians' sources of drug information and generic drug recognition, attitudes, and prescription patterns. The habit of prescribing mostly generic drugs, for example, was found to be more common among family physicians who were residency trained, who relied least on drug company representatives, and who were regular readers of the New England Journal of Medicine. The ability to recognize all ten generic names was found to be highest among these same groups of physicians and also among those who relied least on journal advertisements and those who were regular readers of The Medical Letter.The Journal of family practice 07/1987; 24(6):612-6. · 0.67 Impact Factor
What’s in a Name? Use of Brand versus Generic Drug Names
in United States Outpatient Practice
Michael A. Steinman MD1, Mary-Margaret Chren MD2, and C. Seth Landefeld MD1
1Division of Geriatrics, San Francisco VA Medical Center and the University of California, San Francisco, CA, USA;2Department of
Dermatology, San Francisco VA Medical Center and the University of California, San Francisco, CA 94121, USA.
BACKGROUND: The use of brand rather than generic
names for medications can increase health care costs.
However, little is known at a national level about how
often physicians refer to drugs using their brand or
OBJECTIVE: To evaluate how often physicians refer to
drugs using brand or generic terminology.
DESIGN AND PARTICIPANTS: We used data from the
2003 National Ambulatory Medical Care Survey
(NAMCS), a nationally representative survey of 25,288
community-based outpatient visits in the United
States. After each visit, patient medications were
recorded on a survey encounter form by the treating
physician or transcribed from office notes.
MEASUREMENTS: Our main outcome measure was
the frequency with which medications were recorded on
the encounter form using their brand or generic names.
RESULTS: For 20 commonly used drugs, the median
frequency of brand name use was 98% (interquartile
range, 81–100%). Among 12 medications with no
generic competition at the time of the survey, the
median frequency of brand name use was 100% (range
92–100%). Among 8 medications with generic competi-
tion at the time of the survey (“multisource” drugs), the
median frequency of brand name use was 79% (range
0–98%; P<.001 for difference between drugs with and
without generic competition).
CONCLUSIONS: Physicians refer to most medications
by their brand names, including drugs with generic
formulations. This may lead to higher health care costs
by promoting the use of brand-name products when
generic alternatives are available.
KEY WORDS: drug labeling; drug industry; prescriptions, drug; drugs,
generic; names; prescription fees; ambulatory care.
© 2007 Society of General Internal Medicine 2007;22:645–648
Brand name drugs are often dispensed when bioequivalent
generic alternatives are available, resulting in an estimated
$8.8 billion in excess expenditures per year in the United
States.1This potentially unnecessary use of brand name drugs
may reflect physician and patient beliefs that brand name
drugs are superior to their generic counterparts.2However,
habitual use of brand name terminology may also play an
important role in the dispensing of brand-name products, as
the name recorded on a prescription can impact whether a
drug is dispensed in brand or generic form even when the
physician would accept the generic version, and the pharmacy
is empowered to provide it.3,4
We used data from a large, nationally representative sample
of outpatient visits to evaluate how frequently brand and
generic name equivalents are used in clinical practice.
We used data from the 2003 National Ambulatory Medical
Care Survey (NAMCS), a nationally representative survey of
25,288 community-based office visits to 1,342 physicians in
the United States.5After each sampled visit, forms were
completed by the treating physician or by office staff and/or
survey field representatives (who abstracted information ver-
batim from the medical record to the survey form). All
medications (up to 8) prescribed or continued at the visit were
recorded and subsequently entered into the NAMCS database
using separate numeric codes corresponding to the name
written on the form and to the drug’s nonproprietary name.
The route of administration is not specified in NAMCS;
therefore, oral, topical, and other forms of the same compound
were encoded using a single identifier.
We determined the 20 most frequently mentioned prescrip-
tion medications in NAMCS, excluding vaccinations, combina-
tion products, and medications typically administered in the
office setting. To avoid biasing this list toward specialties that
prescribed and/or recorded many drugs, in this step we
calculated drug frequencies based only on the first medication
listed on the study form. Next, for each of the 20 drugs, we
assessed the frequency of each name that the physician or
assistant had recorded on the form (e.g., for atorvastatin, the
frequency of mentions of “atorvastatin” and “Lipitor”). In this
step we searched all 8 medication fields.
Received August 3, 2006
Revised November 3, 2006
Accepted November 15, 2006
Published online January 10, 2007
In all analyses, we adjusted for sampling probability and
clustering effects to create nationally representative estimates
for each drug present at the clinic visit.6Because numerous
survey strata contained a single primary sampling unit, we
performed our analyses without adjustment for stratification.
This preserves the original point estimate while producing
slightly wider confidence intervals around that estimate.
Finally, we searched the Food and Drug Administration
(FDA) “Electronic Orange Book” (http://www.fda.gov/cder/
ob/docs/queryai.htm) and supplemental sources to assess
the presence of generic competition for each of the 20 drugs.
We considered the date of FDA approval for the first generic
formulation (in any dose or route of administration) to be the
time at which generic alternatives became available. This
research was exempted from review by the institutional review
boards of the San Francisco VA Medical Center and the
University of California, San Francisco.
At least one medication was recorded in 66% of visits. The
majority (89%) of these visits occurred in private solo or group
practice settings, with the most common specialties being
general or family physicians (25%), primary care internists
(16%), pediatricians (10%), and obstetrician–gynecologists
(9%). Survey forms were completed by physicians in 16% of
visits, by office staff in 34%, by census field representatives in
29%, by multiple personnel in 18%, and by other or unrecord-
ed sources in 3%.
The 20 most commonly recorded medications are listed in
Table 1. Overall, the median frequency of brand name use
was 98% (interquartile range, 81–100%), and ranged from 0–
100% of drug mentions. Among the 12 medications with no
generic competition at the time of the survey, the median
frequency of brand name use was 100% (range 92–100%).
Among the 8 medications with generic competition at the
time of the survey, the median frequency of brand name use
was 79% (range 0–98%). This difference was statistically
Because office staff and census field workers completed the
majority of forms, we performed additional analyses to evaluate
if the proportion of brand versus generic names recorded by
physicians differed from the proportion recorded by nonphysi-
cians. For 18 of 20 medications, there were no significant
differences between physicians and nonphysicians in the use of
brand versus generic names (P>=.10 for each). The two
exceptions were azithromycin (brand name used by 92% of
physicians vs 98% of nonphysicians, P=.09) and prednisone
(brand name used by 4% of physicians vs 0% of nonphysicians,
In this nationally representative survey, physicians referred to
medications by their brand names much more frequently than
by their generic names. Brand names were used almost
exclusively for drugs without generic competition at the time
of the survey. Brand name use was also common for drugs
with generic competition, although at lower rates and with
greater variability between drugs. While to our knowledge no
previous studies have evaluated the use of drug terminology on
a national scale, our results are consistent with previous
reports which have found that prescriptions are predominantly
written using brand names.3,4
Table 1. Use of Brand Versus Generic Names for Commonly Prescribed Medications
Generic Name (Brand names*)Mentions
Status in 2003†
Number of Years of
Azithromycin (Z-pack, Zithromax)
Fluticasone (Flonase, Flovent, Cutivate)
Ciprofloxacin (Cipro, Cipro XR, Ciloxan)
Clarithromycin (Biaxin, Biaxin XL)
Metoprolol (Lopressor, Toprol XL)
Amoxicillin (Amoxil, Sumox)
Levothyroxine (Unithroid, Levothyroid, Synthroid, Levoxyl, Levothyroid)
Albuterol (Proventil, Ventolin, Volmax)
Prednisone (Sterapred DS, Deltasone)
Triamcinolone (Azmacort, Aristocort Kenalog, Triam, Triamolone 40, Nasacort)
Fluoxetine (Prozac, Sarafem)
Brand + Generic‡
*Brand names cited by surveyed office practices
†Generic competition available in 2003 versus only brand-name formulations available
‡Metoprolol tartate (Lopressor, a short-acting form) had generic competition before 2003, but metoprolol succinate (Toprol XL, a longer-acting form)
remained under exclusivity protection at the time of the study. In comparative analyses, we classified metoprolol as a generically available drug.
Alternative classifications produced similar results.
§Although formulations of levothyroxine received FDA approval starting in 2000, in practice many formulations have been on the market for decades.
Steinman et al.: Use of Brand versus Generic Drug Names
Physicians may prefer brand names for a variety of reasons.
Brand names are often more memorable or evocative than
generic names and easier to pronounce (in our sample, brand
names had on average 1.5 fewer syllables than their generic
counterparts).7Many physicians may be familiar only with the
brand name of certain drugs or unaware of the correspondence
between generic and brand names.8–10In addition, in certain
cases physicians may believe that generic formulations are not
as effective as the brand name product.11Although the
interchangeability of certain drugs remains a matter of
debate,12many physicians may not be aware of the strict
controls imposed by FDA to prove bioequivalence before a
generic formulation can be approved.13
The use of brand names has substantial economic con-
sequences.14,15Pharmacist substitution of generic equivalents
is generally allowed and is encouraged by third party payers,
and several programs have been developed to encourage
generic substitution.1,16However, generic substitution is not
mandated in most states, can be overridden by the prescribing
physician and does not universally occur even when allowed
by the physician.3,4Overall, 39% of drugs available as generics
were filled with the brand formulation in a recent national
study.1As brand name drugs usually retain a substantial price
premium even after generic equivalents are introduced,17
persistent use of brand name products has resulted in billions
of dollars of excess spending.1
The use of brand names also has consequences for com-
munication between physicians. Confusion over drug termi-
nology can result in adverse drug events. For example, a
patient may inadvertently be given a second formulation of a
drug because the prescribing physician failed to recognize that
the patient was already taking the medication under a different
name.18,19In addition, use of brand names in communication
between physicians can undermine efforts to minimize com-
mercial influence on medical practice.
The use of brand names may reflect habitual use of a lexicon
learned in training or shortly after introduction of new drugs.11
Therefore, efforts to increase the use of nonproprietary names
should focus on these periods of early exposure. Medical
students and residents should be educated about these issues,
and physician supervisors should be encouraged to promote
use of generic terminology in their day-to-day interactions with
trainees. Standards in continuing medical education programs
could also be strengthened: while the Accreditation Council for
Continuing Medical Education (ACCME) encourages the use of
generic names in educational presentations, parts of their
guideline place greater emphasis on balancing the use of
brand names across different companies than on minimizing
the use of proprietary terminology.20Electronic prescribing
systems could also be engineered to convert brand to generic
names. One place to start would be the official Medicare
Prescription Drug Plan Finder website (http://plancompare.
medicare.gov/drugselect.asp), which recognizes only brand
names for drugs that are currently under patent and exclu-
Our study has several limitations. First, data were collected
from research forms. We cannot determine whether physicians
used the same terminology in their daily speech or when
writing prescriptions. Similarly, we do not know to what extent
use of brand name terminology reflected preference for specific
brand formulations (e.g., for a specific brand of levothyroxine).
Second, the majority of data forms were completed by office
staff and survey field personnel. However, subsidiary analyses
showed a similar distribution of brand and generic name use
whether a physician or nonphysician completed the form.
Third, our method for determining when generic competition
first became available does not fully capture the complex
approval histories for different formulations of the same drug.
Finally, our list of drugs was dominated by agents that had no
generic competition, limiting our ability to delineate terminol-
ogy patterns among drugs with generic competition.
Physicians’ preference for brand names may result in higher
health care costs and use of branded products where bioequiv-
alent alternatives are available. The use of nonproprietary
terminology in medicine should be encouraged to save costs,
limit commercial influence, and reduce the potential for
Disclaimer: The views expressed in this manuscript are those of
the authors and do not necessarily reflect the position or policy of the
Department of Veterans Affairs.
and Saunak Sen, PhD for their assistance with data management
and statistical analysis, Priya Kamat, BA for her help investigating
drug approval histories, and Kirby Lee, PharmD for his careful
review of the manuscript.
This work was supported by a VA Health Services Research and
Development Research Career Development award (Dr. Steinman),
by grants from the National Institute on Aging (AG00912) and the
John A. Hartford Foundation (2003-0244) (Dr. Landefeld) and from
the National Institute on Arthritis and Musculoskeletal and Skin
Disease (AR02203) (Dr. Chren), and by support from the HSR&D
Research Enhancement Award Program at the San Francisco VA
Medical Center (all authors). Drs. Landefeld is a Senior Scholar in
the VA National Quality Scholars Program. None of these sponsors
had any role in the study design, methods, analyses, and
interpretation, or in preparation of the manuscript and the decision
to submit it for publication.
The authors thank Daniel Bertenthal, MPH
Author's Contributions: Study concept and design (MAS), acqui-
sition of subjects and data (MAS), analysis and interpretation of
data (all authors), preparation of the manuscript (MAS), and critical
review of the manuscript (all authors). Dr. Steinman had full access
to all of the data in the study and takes responsibility for the
integrity of the data and the accuracy of the data analysis.
Copyright notice: All of the authors are employees of the United
States government and cannot transfer copyright rights for this
manuscript to the publisher.
Potential Financial Conflicts of Interest: The authors have no
financial conflicts of interest with products discussed in the
Corresponding Author: Michael A. Steinman, (e-mail: mike.stein-
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