Generic Drugs: Their Use Saves Consumers Billions of Dollars, But Consumers Could Do Better If Doctors Cooperated

About 70% of all prescriptions for drugs are filled with generic drugs. The move to generic drugs has occurred for many reasons including a landmark 1984 federal law that encouraged their development. Another reason is that laws in many states require pharmacies to give consumers the generic version of a prescription drug whenever a generic version is available, even if the doctor prescribes the brand name. In the aggregate, these laws, pressure from insurers, and growing acceptance of generic drugs by many doctors, save consumers (and their public and private insurers) tens of billions of dollars every year.

But there is a big exception in the state "generic substitution" laws: When doctors prescribe brand name drugs and demand that the pharmacist "dispense as written" (that is, when they write "DAW" on their prescription pads), the pharmacist generally must fill the prescription with the brand name drug. About 5% of all prescriptions are DAW, costing consumers lots of money.

How much money? Well, the difference in price between brand name and generic drugs can be very large. Here's one example from an informative article in today's Washington Post on DAW prescriptions:

Take . . . the popular anti-cholesterol drug Zocor. According to Drugs.com, a 90-pill bottle costs $459.98. But 90 pills of simvastatin, the generic version of Zocor, are only $83.97. Buy simvastatin at Wal-mart or Target, which offer special pricing programs, and the cost comes down to just $12.

Why do doctors insist on DAW? According to the Post article, because (1) some doctors wrongly believe that generic drugs are unsafe or ineffective; (2) some doctors frequently remember only the brand name not the generic name of the drug (which doesn't seem like a reason to use DAW); and (3) some doctors are influenced by brand name advertising.

As the Post explains, some states trying to curb DAW prescriptions:

 In 2009, for example, Massachusetts began requiring doctors to explain in writing why they were insisting — via a DAW — on a brand-name medication as opposed to a generic. The results were dramatic. According to the Generic Pharmaceutical Association, the state’s Medicaid spending for drugs fell by $150 million within a year.

It will be interesting to see whether other states follow Massachusetts' lead.

Comments

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Drug companies like Glaxosmithkline (GSK) and Merck are amongst the most profitable companies in the world. Arguably the drugs they research and produce are among the most important products any company sells. Although the proposition could choose to discuss the advertising of non-prescription drugs, a better debate can be had over prescription drugs (drugs requiring a doctor’s authorization before a pharmacist can dispense them to a patient) because states across the world have taken very different positions on the issue.

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I'm in no way an expert on this, and I do not imagine for a moment that C-E analysis is a sufficient moral guide for medical decision making. My concern is that these days we are thinking ONLY about cost, and not about the tremendous value that medicine also delivers.

A premise of Healthy Survivorship is that each individual adopts and develops the language that works well for him or her.

For me, "normal" in this context has connotations of regular, usual, natural. For years I dealt with big and little crises and discomforts (pain) that made "normal" an elusive goal.

For me, the notion of developing a "new normal" that integrated the changes and losses that accompanied my illness enabled me to regain that comforting sense of normalcy that would otherwise have been impossible. For me, the notion of a "new normal" helped me get good care and live as fully as possible.

Since the phrase doesn't work for you, I hope you can find other language that does. I'd also appreciate your sharing, if you don't mind, because it could help me understand you and others who don't find comfort in the notion of a new normal.