Use of Generic Cardiovascular Medications by Elderly Medicare Beneficiaries Receiving Generalist or Cardiologist Care

Division of General Internal Medicine, Mount Sinai School of Medicine, New York 10029, USA.
Medical Care (Impact Factor: 3.23). 03/2007; 45(2):109-15. DOI: 10.1097/01.mlr.0000250293.24939.2e
Source: PubMed


Elderly Medicare beneficiaries can reduce out-of-pocket spending and increase their options for low-cost Medicare Part D plans by using generic drugs. Physicians play a key role in determining use of generics and specialty may be a particularly influential factor.
We sought to compare generic cardiovascular drug use by older adults receiving cardiologist and generalist care.
We undertook a cross-sectional analysis of data from the nationally representative Medicare Current Beneficiary Survey. Included were community-dwelling adults 66 years of age or older with hypertension, coronary disease, or congestive heart failure, one or more Medicare Part B claims for outpatient visits with generalists (internist or family practitioner) or cardiologists, using one or more cardiovascular drug available in both brand-name and generic formulations (n = 1828).
The primary outcome was use of one or more generic medication aggregated across 5 drug classes: beta-blockers, thiazides, calcium channel blockers (CCB), angiotensin-converting enzyme (ACE) inhibitors, and alpha1-adrenergic receptor antagonists. Within-class generic use also was examined. The main independent variable was cardiologist (20.7%) versus generalist-only care (79.3%).
In the aggregate, fewer individuals under cardiologist care used generics compared with generalist-only care (75% vs. 81%, P = 0.03; adjusted relative risk 0.89, 95% confidence interval = 0.79-0.99). Overall use of generic beta-blockers was 86.6%; thiazides, 92.0%; ACE inhibitors, 59.0%; CCB, 55.5%; alpha-blockers 47.7%. In adjusted analysis, generic CCB use occurred 34% less often among cardiologist versus generalist-only patients.
Older patients of generalists and, to a greater extent, cardiologists, often use brand-name drugs when generic equivalents are available. Promoting generic prescribing among specialists and generalists may increase opportunities for patients and third-party payers to reduce spending on prescription drugs.

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    • "Other factors that may influence patients’ attitudes towards generic medicines are believed to be the physicians’ prescribing behaviour and their preferences for particular originator brand or their bias against generics [16]. Moreover, the information given by a prescribing physician on generic substitution was also found to be a main driver that influences patients’ beliefs about generic medicines and their consumptions [13,17]. "
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    ABSTRACT: Objective The aim of this study was to explore Jordanian patients’ perceptions toward generic medicines and to evaluate their opinions regarding generic substitution. Method A cross-sectional descriptive study involving Jordanian patients was undertaken, using a self-administrated anonymous questionnaire. The response rate was 80% (n=400/500). Results The study showed that cost of medicines is high according to 83% of the patients. Most patients (92%) preferred to be prescribed the cheapest medicine. Majority of patients (79%) believed that cost should be considered before a drug is prescribed. Most patients (78%) accepted generic substitution and believed that it can provide significant saving. Surveyed patients (78%) agreed that they should have the option of choosing between generic and originator and 74% believed that physicians should give them that choice. These results showed a significant statistical correlation with the monthly income of the patient, percentage cost they pay and number of medicines prescribed (P<0.05). Conclusion The high cost of medicines in Jordan is believed to be the main driver for choosing generic medicines Furthermore; patients have positive attitudes towards generic medicines. The involvement of patients in the treatment decision would result in more adherence and improvement in health. The insights gained from patients in this study will be useful to health organisations and policy makers to design a robust generic policy to use medicines cost-effectively in Jordan.
    Full-text · Article · Jun 2013 · Journal of Pharmaceutical Policy and Practice
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    • "Multiple factors contribute to generic drug use, including systems-level factors, such as insurance restrictions or state generic substitution laws; provider-level factors, such as physician beliefs or practices (1,5); and patient-level factors, such as consumer perceptions. Negative perceptions of generic medications are higher among the elderly, minorities, and people with low socioeconomic status and health literacy (6,7). "
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    ABSTRACT: Using generic medications for chronic diseases provides efficacy similar to that of brand-name medication use, but at a lower price, potentially enhancing adherence. However, previous studies show that disadvantaged people, who may particularly benefit from cost savings, have low trust of generics and increased reluctance to switch to generics. The rural South includes areas of high poverty and minority communities whose members are at high risk for poor health outcomes; however, whether such beliefs exist in these communities has not been reported. We sought to obtain qualitative insight into beliefs about generic medication use among African Americans in the rural South. Investigators conducted 4 focus groups with 30 community members from Alabama's Black Belt area. Transcribed discussions were analyzed and common themes identified. Participants were primarily unemployed middle-aged women, one-fourth of whom were uninsured and more than half of whom had a high school education or less. Barriers to generic medication use included perceptions that generics are less potent than brand-name medications, require higher doses, and, therefore, result in more side effects; generics are not "real" medicine; generics are for minor but not serious illnesses; the medical system cannot be trusted; and poor people are forced to "settle" for generics. Although education about generics could rectify misinformation, overcoming views such as mistrust of the medical system and the sense of having to settle for generics because of poverty may be more challenging. Policy makers and providers should consider these perspectives when working to increase generic drug use in these populations.
    Full-text · Article · Aug 2012 · Preventing chronic disease

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