In our "Money Mic" series, we hand over the podium to someone with a strong opinion on a financial topic.
Today, Eric Campbell, director of research at the Mongan Institute for Health Policy, tackles how the marketing of prescription drugs to consumers and doctors increases demand for pricey meds that aren't necessarily better than generics.
Get started with a free financial assessment.
Get started with a free financial assessment.
Generic drugs aren't the same thing as generic groceries.
If you buy generic macaroni and cheese, you likely know that it's not going to taste as good—but you're willing to accept that in exchange for a reduced price.
This isn't the case with medicine.
Generic drugs are required by law to be identical to brand-name equivalents in strength, dosage and how they’re administered. Yet, by design, generics are much, much cheaper. So when they enter the market, generic meds can drive down costs by 65% or more.
There's another value to generics: Pretty much everyone in the medical field knows how they work—and their potential side effects—since they've typically been on the market for longer periods of time.
But despite these benefits to consumers, pharmaceutical companies rarely advertise generic or off-patent products to patients. Instead, direct-to-consumer marketers push the newest, most expensive drugs and devices—many of which are no better and, in some cases, even worse than a generic available at a lower price. For example, the pain medication Vioxx and the diabetes drug Avandia have been plagued with adverse side effects not seen with older generic treatments.
Translation: Sure, patients may be better aware of brand-name drugs, thanks to the persuasive power of direct marketing, but they aren't necessarily better educated about these medications. And it all comes down to one thing: Glossy marketing campaigns lure consumers—and sometimes even doctors—into thinking that the newest prescription medicines are superior.
Giving in to Patient Demands
So why would a physician prescribe a brand-name drug to a patient when there are more affordable generics out there? To get to the answer, the Mongan Institute for Health Policy surveyed nearly 1,900 doctors across the country and across various specialties.
The eye-opening findings: Nearly 40% of doctors said that they prescribed brand-name drugs when a patient specifically asked for them—even though this was a potentially wasteful practice. How so, you ask? Well, according to the latest data from the Food and Drug Administration, generics saved the U.S. $158 billion in health-care costs in 2010.
The survey also found that doctors who prescribed requested brand-name drugs tended to be older—and, more often than not, regularly "met with drug companies to stay up-to-date." In case you're wondering, that's code for advertising to physicians.
The interesting thing is that, if you ask physicians, they'll typically say that payments from drug companies have no influence on what they themselves prescribe. But if you inquire about their colleagues, they almost all say that payments have a big influence on fellow doctors. It's a sad game of self-deception, because we don’t like to admit that others have influence over our actions.
If we believed that drug companies were best qualified to educate doctors, we'd base medical schools inside of pharmaceutical companies.
Here's a closer look at that influence: Drug makers spent more than $24 billion marketing meds to doctors in 2012, according to the research firm Cegedim Strategic Data. And the Accreditation Council for Continuing Medical Education reports that drug and device companies sponsored nearly a third of the medical training that the ACCME tracks.
If we believed that drug companies were best qualified to educate doctors, we'd base medical schools inside of pharmaceutical companies. But we don't. Instead, doctors should have access to the newest, most important and unbiased information through professional associations, medical journals and lectures.
My Prescription for Change
This is what I tell people: If you're on a generic drug that you're tolerating well, and a physician suddenly wants to switch you to a brand-name drug that just came out, ask these sensitive yet necessary questions:
- What is the clinical evidence suggesting that this drug is better than the generic?
- Do you have a financial relationship with the company making this medication that might possibly motivate you to switch me?
In fact, patients will soon be able to take it a step further and use the internet to investigate whether a doctor is receiving payments from drug companies. Under the Patient Protection and Affordable Care Act signed into law in 2010, pharmaceutical companies will be required to provide this information to a government database beginning in 2014. (In the meantime, you can check ProPublica’s Dollars for Docs database, which compiles data from 15 drug companies on the doctors who receive payments to promote their products.)
It's a good first step, but even more should be done. For starters, we need honest policy debate on the appropriate role of pharmaceutical companies when it comes to both lobbying and advertising directly to consumers and doctors.
It's also worth noting that the U.S. is only one of two countries in the entire world that hasn’t banned direct-to-consumer pharmaceutical marketing. (In case you're wondering, the other holdout is New Zealand.)
On a local level, states can implement mandatory conversion programs, which allow pharmacists to switch patients to a generic alternative even if a doctor has written a script for a brand-name medication. States can also crack down on the practice of allowing pharmaceutical companies to peddle free drug samples and meals to doctors—both of which drive prescription-drug spending.
Doctors and patients should be able to work together, but if physicians are being paid directly or even indirectly for what they are prescribing, then shared decision-making is thrown off balance. This is why patients should not only be proactive about asking for generics upfront, but they should also question physicians who push glossy, brand-name drugs. With these reasonable steps, patients can take care of both their health and their finances.
Eric Campbell is a professor at Harvard Medical School who specializes in researching physician conflict of interest and professionalism.