Patient, Physician, Pharmacy, and Pharmacy Benefit Design Factors Related to Generic Medication Use

ArticleinJournal of General Internal Medicine 22(9):1298-304 · October 2007with13 Reads
DOI: 10.1007/s11606-007-0284-3 · Source: PubMed
Increased use of generic medications conserves insurer and patient financial resources and may increase patient adherence. The objective of the study is to evaluate whether physician, patient, pharmacy benefit design, or pharmacy characteristics influence the likelihood that patients will use generic drugs Observational analysis of 2001-2003 pharmacy claims from a large health plan in the Western United States. We evaluated claims for 5,399 patients who filled a new prescription in at least 1 of 5 classes of chronic medications with generic alternatives. We identified patients initiated on generic drugs and those started on branded medications who switched to generic drugs in the subsequent year. We used generalized estimating equations to perform separate analyses assessing the relationship between independent variables and the probability that patients were initiated on or switched to generic drugs. Of the 5,399 new prescriptions filled, 1,262 (23.4%) were generics. Of those initiated on branded medications, 606 (14.9%) switched to a generic drug in the same class in the subsequent year. After regression adjustment, patients residing in high-income zip codes were more likely to initiate treatment with a generic than patients in low-income regions (RR = 1.29; 95% C.I. 1.04-1.60); medical subspecialists (RR = 0.82; 0.69-0.95) and obstetrician/gynecologists (RR = 0.81; 0.69-0.98) were less likely than generalist physicians to initiate generics. Pharmacy benefit design and pharmacy type were not associated with initiation of generic medications. However, patients were over 2.5 times more likely to switch from branded to generic medications if they were enrolled in 3-tier pharmacy plans (95% C.I. 1.12-6.09), and patients who used mail-order pharmacies were 60% more likely to switch to a generic (95% C.I. 1.18-2.30) after initiating treatment with a branded drug. Physician and patient factors have an important influence on generic drug initiation, with the patients who live in the poorest zip codes paradoxically receiving generic drugs least often. While tiered pharmacy benefit designs and mail-order pharmacies helped steer patients towards generic medications once the first prescription has been filled, they had little effect on initial prescriptions. Providing patients and physicians with information about generic alternatives may reduce costs and lead to more equitable care.
    • "For example, many claimsbased studies have focused upon analyses of healthcare utilization in response to benefit design (co-pays, co-insurance , deductible thresholds, etc.) or alternative therapeutic interventions such as drug treatments for a given condition. These studies often implicitly assume that the data represent consumer behaviour456789. There are two inherent limitations in most of these prior studies. "
    [Show abstract] [Hide abstract] ABSTRACT: Aim: Missing data, particularly missing variables, can create serious analytic challenges in observational comparative effectiveness research studies. Statistical linkage of datasets is a potential method for incorporating missing variables. Prior studies have focused upon the bias introduced by imperfect linkage. Methods: This analysis uses a case study of hepatitis C patients to estimate the net effect of statistical linkage on bias, also accounting for the potential reduction in missing variable bias. Results: The results show that statistical linkage can reduce bias while also enabling parameter estimates to be obtained for the formerly missing variables. Conclusion: The usefulness of statistical linkage will vary depending upon the strength of the correlations of the missing variables with the treatment variable, as well as the outcome variable of interest.
    Article · Dec 2015
    • "Another factor is that patients are encouraged to use generic medicines by making them pay significantly less co-payment when selecting generic medicines as most pharmacy plans and designs and insurers adopted formularies with three tier co-payment. In this system or plan, patients pay the lowest co-payment for generic medicines (first tier), a middle copayment for preferred brand name medicine (second tier) and the highest co-payment for the expensive non-preferred brand name medicine (third tier) (Huskamp et al., 2003; Kohl and Shrank, 2007; Shrank et al., 2006 Shrank et al., , 2007; Congressional Budget Office (CBO) Congress Of The United States, 2010). For example, in 2009, in Stand-alone prescription-drug plan, average co-payment for generic medicines was USD $ 7, while for preferred brand medicines and non-preferred brand medicines , it was USD $ 37 and $ 75 respectively (Neuman and Cubanski, 2009 ). "
    [Show abstract] [Hide abstract] ABSTRACT: Generic medicines are clinically interchangeable with original brand medicines and have the same quality, efficacy and safety profiles. They are, nevertheless, much cheaper in price. Thus, while providing the same therapeutic outcomes, generic medicines lead to substantial savings for healthcare systems. Therefore, the quality use of generic medicines is promoted in many countries. In this paper, we reviewed the role of generic medicines in healthcare systems and the experiences of promoting use of generic medicines in eight selected countries, namely the United States (US), United Kingdom (UK), Sweden, Finland, Australia, Japan, Malaysia and Thailand. The review showed that there are different main policies adopted to promote generic medicines such as generic substitution in the US, generic prescribing in the UK and mandatory generic substitution in Sweden and Finland. To effectively and successfully implement the main policy, different complementary policies and initiatives were necessarily introduced. Barriers to generic medicines use varied between countries from negative perceptions about generic medicines to lack of a coherent generic medicine policy, while facilitators included availability of information about generic medicines to both healthcare professionals and patients, brand interchangeability guidelines, regulations that support generic substitution by pharmacists, and incentives to both healthcare professionals and patients.
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    • "Perhaps most interesting is that, in 2012, Shrank et al. found that a meaningful proportion of physicians expressed negative perceptions about generic medications, representing a potential barrier to generic use. The researchers recommended that policymakers trying to encourage generic use should consider educational campaigns targeting older physicians [123]. Similar results were seen in a study carried out amongst Irish prescribers in 1997, which showed that the majority of prescribers were concerned about the reliability and quality of generic medicines [75], and the study concluded that education of stakeholders would be necessary to improve the level of INN prescribing in Ireland. "
    [Show abstract] [Hide abstract] ABSTRACT: Generic medicines are those where patent protection has expired, and which may be produced by manufacturers other than the innovator company. Use of generic medicines has been increasing in recent years, primarily as a cost saving measure in healthcare provision. Generic medicines are typically 20 to 90% cheaper than originator equivalents. Our objective is to provide a high-level description of what generic medicines are and how they differ, at a regulatory and legislative level, from originator medicines. We describe the current and historical regulation of medicines in the world's two main pharmaceutical markets, in addition to the similarities, as well as the differences, between generics and their originator equivalents including the reasons for the cost differences seen between originator and generic medicines. Ireland is currently poised to introduce generic substitution and reference pricing. This article refers to this situation as an exemplar of a national system on the cusp of significant health policy change, and specifically details Ireland's history with usage of generic medicines and how the proposed changes could affect healthcare provision.
    Full-text · Article · Jan 2013
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