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Patient Requests for Brand-Name Drugs Often Fulfilled by Physicians

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Business relationships within the industry may be fueling this practice

When patients request a brand-name drug, more than one-third of US physicians often or sometimes prescribe brand-name drugs when appropriate generic substitutes are available, according to a national survey. Moreover, physicians with marketing relationships within the industry are more likely to fulfill these patient requests, the survey indicated.

“The good news is that 63% of physicians indicated they never or rarely prescribed a brand-name drug instead of an equivalent generic simply because of a patient request. However, our data suggest that a substantial percentage – 37% or about 286,000 physicians nationally – do meet those requests,” says Eric G. Campbell, PhD, Mongan Institute for Health Policy (MIHP) director of research, and study leader. “Since generics are from 30 to 80% cheaper than the brand-name versions, that would represent a significant source of unnecessary health costs.”

When the 2009 survey of medical professionalism was sent to 3500 physicians (500 each in anesthesia, cardiology, family practice, general surgery, internal medicine, pediatrics, and psychiatry), nearly 1900 physicians responded. The survey included a question asking physicians to indicate whether they had “prescribed a brand-name drug when an equivalent generic was available because the patient asked for the brand-name drug specifically” during the previous year. Response options were “never,” “rarely,” “sometimes,” and “often,” and approximately 40% of the physicians answered “sometimes” or “often.”

Those more likely to honor brand-name drug requests included:

  • Physicians who had been in practice more than 30 years
  • Physicians in solo or 2-person practices
  • Physicians specializing in internal medicine and psychiatry
  • Physicians receiving industry-sponsored food or beverages in the workplace and receiving free drug samples

In response to these survey results, the authors offer these solutions as a means to reduce unnecessary brand name prescribing:

  • Educate patients and physicians regarding the wastefulness of the practice
  • Require drug samples to go through hospital and health system pharmacies
  • Prohibit industry-provided food and beverages from hospital and health system sites

“Reducing or eliminating this practice represents low-hanging fruit in terms of reducing unnecessary spending in medicine. However, doing so will likely be unpopular with some patients, physicians and certainly with the drug industry,” said Christine Vogeli, PhD, of the MIHP, study coauthor.

The report from investigators at the MIHP at Massachusetts General Hospital has been released online and will appear in JAMA Internal Medicine.

Source: Massachusetts General Hospital.