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Giving in to patient demands for brand-name drugs could be adding unnecessary costs to healthcare system


Years in practice, specialty, and practice size were factors when researchers examined the likelihood that a physician would honor a patient's request for a brand-name drug rather than a generic. The investigators suggest two solutions to reduce the practice, which if followed could save costs in the healthcare system.

Physicians giving in to patient requests for brand-name medications even when suitable generics are available could be adding substantial unnecessary costs to the healthcare system, according to researchers who conducted a new study published online by JAMA Internal Medicine.

In a survey to which 1,891 doctors in seven specialties responded, about 40% reported that they sometimes or often prescribe a brand-name medication to a patient when a generic is available because the patient wanted it.

Forty-three percent of doctors in practice for more than 30 years are guilty of the practice, researchers found, whereas physicians in practice for 10 or fewer years were less likely (31%) to acquiesce to patient demands for brand-name drugs.

Also, those in solo and two-person practices were more likely to honor patient demands than those working in hospitals or medical schools (46% versus 35%).

The study also found that doctors who receive food and beverages or drug samples, or who meet with representatives from the pharmaceutical industry, are more likely to comply with patient requests for brand-name medications.

Pediatricians, anesthesiologists, cardiologists, and general surgeons were the least likely among various specialties to give in to patient requests.

The study did not consider how many of the name-brand prescriptions were filled with name-brand drugs at the pharmacy level, but its authors suggest several interventions that could possibly help reduce these practices:

  • Giving pharmacies primary control over whether a patient receives brand-name or generic medications is one possible solution, but it would require the ability for a physician to override that pharmacy’s decision when necessary, as in cases of allergies to generic medications.

  • Another suggestion is to prevent physicians from accepting samples or food and beverages from pharmaceutical representatives. The study suggests that interventions be directed at older physicians, internists, and those in solo or two-person practices.




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Jennifer N. Lee, MD, FAAFP
© National Institute for Occupational Safety and Health
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