Prescribing generics instead of brand-name drugs can improve adherence and also cut costs, according to new best practice advice from ACP.
ACP's Clinical Guidelines Committee conducted a literature search in 2014 with the goal of helping internists and other clinicians make high-value, cost-conscious choices regarding use of generic drugs. They found that most (although not all) studies examining the effect of generics versus brand-name drugs on adherence in chronic disease showed better long-term adherence with the former. The evidence also indicated that brand-name medications do not appear to have an efficacy advantage when compared with molecularly identical generic drugs and that use of generic drugs decreases patients' out-of-pocket costs.
The main barriers to more widespread of use of generic drugs are physicians' perceptions about their safety and efficacy and patients' expectations and preferences, the committee noted. Tiered formulary copayment systems, education of physicians and patients, prior authorization and step therapy requirements, physician performance measures, and use of electronic health records to notify physicians about formulary status and out-of-pocket costs are all strategies that could increase use of generics, the committee wrote, although it noted that the evidence base supporting such strategies can be limited.
The committee provided the following talking points for clinicians to use in conversations with patients:
- Brand-name medications are not necessarily more efficacious.
- The generic versions of a particular brand-name medication may come in different shapes, sizes, and colors but offer the same benefit.
- Dosage levels vary for different medications, including brand-name and generic alternatives that are used to treat the same condition, and similar dosages may not necessarily achieve the same outcome.
- Changing from brand-name to generic medication reduces patient costs.
- Changing from a generic medication to a brand-name medication is rarely indicated in patients with chronic diseases that are already well-controlled.
The committee concluded that clinicians should prescribe generic medications instead of more expensive brand-name medications when possible. They noted that more research is needed on the comparative safety and effectiveness of generics compared to brand-name drugs, as well on the best strategies to increase generic use. The best practice advice paper was published online by Annals of Internal Medicine on Nov. 24.