Recent news coverage of health plans’ requirement that patients try less expensive generic drugs before covering more expensive, brand-name prescription drugs might leave reasonable people concerned.
Don’t be.
A variety of prescription drugs are available to treat many conditions. More generics are available now than ever before. And, doctors agree, choosing the right drug isn’t a “one size fits all” proposition.
Yet, in the absence of a contraindication for any specific patient, common sense (and volumes of scientific evidence) suggest it’s best to start with proven drugs that are effective for the vast majority of people. Beyond that prerequisite, there’s no point in stepping up to more expensive brand-name drugs, unless a doctor determines it’s in the best interest of the patient.
This step-by-step process is the foundation not only of prescribing drugs, but of all medicine. “When you hear hoof beats,” young medical students are taught from Day One, “don’t start by looking for zebras.”
Neither should doctors look first to the newest or most heavily advertised drugs to treat things like high cholesterol. With prescription drugs, “new” does not necessarily mean better. Sometimes, it means “worse” (remember Vioxx?). Often, the most heavily advertised drugs are no better for most patients than those with long track records of safety and efficacy.
Generally, the most significant difference between well-known, brand-name drugs and their generic counterparts is their price. For the vast majority of patients seeking to lower their cholesterol, the relatively small differences in formulations between generic and brand-name statin drugs aren’t usually sufficient to warrant paying two, three, or 10 times as much for the one whose patents have not yet expired.
Importantly, for those patients for whom a higher-priced, brand-name drug does make medical sense, there are alternatives. Many insurers will allow coverage for this “next step” when a doctor concludes it’s medically necessary to serve the patient. And even when coverage isn’t available, options are.
Public skepticism – perhaps grounded in fears that managing cost means limiting access to drugs, doctors and care – is understandable, but unwarranted. Organizations and physicians continue to apply more enlightened approaches based on medical and scientific evidence, quality improvement and patient engagement.
Old suspicions may die hard, especially amid multi-billion-dollar advertising campaigns by pharmaceutical companies, but before dismissing your doctor’s recommendation of a generic drug, consider the following.
The Food and Drug Administration recognizes generics as a safe and smart option. Every single generic drug that reaches the U.S. market passes the same rigorous safety and efficacy review and approval processes as any brand-name drug.
The Puget Sound Health Alliance, composed of more than 140 physician, consumer, hospital, employer, insurer and other groups, strongly supports the use of generics as drugs of first choice when appropriate for individual patients. Such diverse organizations don’t always agree on contentious issues, but on this one, there is strong support.
Most of our region’s highly regarded physicians and medical experts concur. Working with the Alliance, they’ll be part of a forthcoming effort to help patients see the value in generics as a smart choice for good health and for more affordable care.
Common sense suggests resisting the temptation to believe everything we see or hear in advertising, or to assume that a brand name alone makes a drug better.
In the final analysis, your choice is between scientifically demonstrated results that can also make health care more affordable, and the pervasive claims of well-financed drug marketing campaigns.
When you consider whom to trust, remember that education is the strongest medicine, and common sense the best prescription.
Hugh Straley, MD, is medical cirector of Group Health and vice chair of the board of Puget Sound Health Alliance. John Verrilli, MD, is an internist at Minor &James Medical, chief of medicine at Swedish Medical Center, First Hill, and a member of the Alliance’s Clinical Improvement Team on Pharmaceuticals.
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