Friday, July 28, 2006

Generics: Physicians Less Informed than Consumers!

"Only your doctor can tell you if [Brand Drug Name Here] is right for you." is a phrase often seen in brand DTC (direct to consumer) print and TV ads. If generic drugs were advertised like their brand equivalents, the ads could
not say "Only your doctor can tell you if [Generic Drug Name Here] is right for you."

That's because, when it comes to misconceptions about generic drugs, physicians score higher than consumers.

According to the "
2006 Drug Trend Report" by Medco:
"The survey found that physicians trail consumers and pharmacists regarding their knowledge of and confidence in the safety and effectiveness of generic drugs which could have broad implications for the forthcoming boon in savings from the expected drug patent expirations of branded drugs worth over $40 billion in U.S. sales:
  • "One quarter of the physicians surveyed stated that they do not believe generic medications to be chemically identical to their branded counterparts; more than 8 percent said they were unsure. This despite FDA rules that require generic versions of the drug be bioequivalent to the brand medication
  • Nearly one in five physicians believes generic drugs are less safe than brand-name medications, and more than one in four doctors (27 percent) believe generic medications will cause more side effects than brands"
(See chart below.)

Pharmacists, on the other hand, know the score on generics.

It's shocking that physicians are less savvy about generics than their patients. But to understand why so many physicians harbor misconceptions about generics we need to look at the pharmacist data and ask: Why aren't the numbers for physicians closer to their professional pharmacist colleagues?

The one distinguishing factor is detailing by pharmaceutical sales reps. Only physicians are detailed on the "benefits" of brand name drugs vs. generics by sales reps. Pharmacists are merely urged to stock enough drugs to handle the expected surge of prescriptions resulting from a sales campaign.

When a brand drug faces generic competition, a major goal of the reps' "benefit" spiel to physicians is to cast doubt on the efficacy and safety of the generic equivalent. It appears that a substantial number of physicians swallow this spiel hook, line and sinker.
"With such overwhelming clinical evidence over a long period of time validating the therapeutic benefits of generic medicines, these survey results underscore the need to redouble our educational outreach efforts to physicians concerning generics," said Dr. Robert Epstein, Medco's Chief Medical Officer. "Generics deliver the dual benefit of quality therapy that provides economic benefits to the patient and payor, ensuring prescription healthcare remains affordable and accessible."
The drug industry spends $1 billion dollars per year on CME-accredited physician education, which can only mention drugs by their generic names. Despite that -- or should we say because of that -- doctors are still not educated when it comes to generics!

We shouldn't expect CME (continuing medical education) sponsored by pharma companies to help physicians understand generics. Most of this support comes from companies with new Rx brands entering the market when generics are not available. The physician is being educated to link the brand name with the great benefits and safety profile being presented simply because only the brand name drug is out there being promoted by PR (see "Marketing Disguised as PR").


  1. Anonymous9:51 AM

    Lovely, thanks for posting this. When discussing generic drugs with patients at the pharmacy, they often want to "talk to their doctor" about it. I've known for a while that doctors are less educated than pharmacists when it comes to brand vs generic drugs, but it's nice to see some statistical data to back up what I already know.

    Sometimes it irritates me -- in chain pharmacies, individual pharmacies within the chain are measured by many things, one of them being generic conversion rates -- and I'll go out of my way to convince a particularly adamant patient to switch. For instance, Celexa. Well we carry the Inwood brand generic which is the "authorized" generic. It's actually made by Forest, and the Inwood bottle even says it's made by Forest. I showed the patient the tablets (virtually identical, the numbering was slightly different), showed her the bottle ("See? They're both made by Forest.") and I still got the same response: "I'll talk to my doctor first."

    At that point you just kind of give up. Of course, that's an extreme example but this "talking to my doctor" nonsense is just that: nonsense.

    ("Talk to my doctor" is usually a euphemism for "do nothing [because I'm comfortable and I don't like change even if it will save me money.]") I'm jealous of some of the other states which require mandatory substitution at that point. ;)

  2. All that rich food and wine must have made the MD's a little "tired and irrational", maybe?

  3. Anonymous11:20 AM

    In India The situation is entirely diffrent. The generic Maximum Retail Price is same as the brand. Hefty margins are given to dispensing Doctors and Pharmacists.
    Our government is unable to contain this problem.The trade margin runs usually between 100 to 1200%. Doctors in india rural areas and in hospitals prefer using generics as the trade margins are good. Most of the generics have some unspellable brand name so that they are passed of as brands.
    bhava narayana editor pharmed trade news india

  4. John -

    You're either misinformed, stupid, or both. Of course pharmacists are going to push generics as best for patients - THEIR MARGINS ARE HIGHER. Most physicians know that generic medications have a dose variance from the brand (at least +/- 5% to 10% if I remember correctly). That means a 10-20% swing in dose that varies from generic manufacturer to manufacturer and even batch to batch on the same medication. Not a big problem for many drugs but it causes a huge problem for narrow therapeutic drugs like thyroid medications. Not chemically equivalent may translate to less effective, more side effects, and less safe.
    The "miconception" is really about who funded the 2006 Drug Trend Report...MEDCO, which equals PHARMACISTS. Think before you rant.

  5. Stupid? I know I am but what are you? Also, WHO are you?

    While you can question the bias of the source of the data I cite, you don't allow me that option -- you don't identify yourself and you don't cite the source for the %5% and 10% variance numbers you seemingly pull out of thin air. [Despite several Google searches, I could find no references to support those numbers.]

    I, on the other hand, can cite the FDA, which says flatly that it "requires generic drugs to have the same quality, strength, purity and stability as brand-name drugs." (See "Generic Drugs: Questions and Answers")

    Here's another statement from the FDA assuring physicians that they can safely administer generics:

    Based on FDA's determination of therapeutic equivalence between generic and innovator drug products, the FDA concludes that:

    * Additional clinical tests or examinations by the health care provider are not needed when a generic drug product is substituted for the brand-name product.
    * Special precautions are not needed when a formulation and/or a manufacturing change occurs for a drug product provided that the change is approved according to applicable laws and regulations by the FDA.
    * As noted in the "Orange Book," in the judgment of the FDA, products evaluated as therapeutically equivalent can be expected to have equivalent clinical effect whether the product is brand name or generic drug product.
    * It is not necessary for the health care provider to approach any one therapeutic class of drug products differently from any other class, when there has been a determination of therapeutic equivalence by FDA for the drug products under consideration.

    (See "Therapeutic Equivalence of Generic Drugs: Letter to Health Practitioners")

    If the FDA, which tends to side with the brand pharmaceutical industry, says this, then I tend to think it's true.

    Meanwhile, most of the criticisms of FDA-approved bioequivalence of generics have come from the brand pharmaceutical companies -- supported by PhRMA -- challenging genric approvals with a blitzkrieg of citizen petitions (see "Petitions to FDA Sometimes Delay Generic Drugs" - Washington Post).

    Apparently, according to PhRMA, the only good generic drug is an "authorized" generic drug; ie, a drug that is distributed by a generic company with permission from the brand company.

  6. john,
    here in india its quite strange.
    a branded formulation and its generic equivalent marketed by the same company and available at the same retailer!
    how do you explain this?
    as is mentioned,drs lack of seriousness in updating themselves with better options available for their patients,their misplaced priorities(so what,if i prescribe a costly brand?),their unwritten commitments with pharma companies - no wonder generics are never a favorite.the prescriptions are highly motivated not necessarily by a desire to treat with minimum possible but also to satisfy pharma companies marketing gimmicks!

    bharath iyer


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