BRANDED VS GENERIC PHARMACEUTICALS

How to Ensure a Drug is Dispensed as Written

Educating patients about the differences between brand-name and generic ophthalmic drugs is one of several effective strategies.

By Virginia Pickles, Contributing Editor

When a provider writes — or clicks — “no substitution” or “dispense as written” on a prescription form, there’s no guarantee the preferred drug will be dispensed. Depending on circumstances — if a brand-name drug is not on a third-party payer’s formulary or if the copay is high — a patient may request a less costly generic alternative. What’s more, pharmacists proactively alert patients to the availability of generic equivalents, and some health plans and pharmacy benefit managers offer incentives to providers when they successfully make a switch from brand to generic.¹

Another tactic to increase generic drug utilization was explored at the University of Pennsylvania School of Medicine. Researchers there changed the default setting on electronic health records in the general internal and family medicine clinics to initially display only generic equivalents of beta-blockers, statins and proton-pump inhibitors, with the ability to opt out.² They concluded that making generic drugs the default choice for prescribers may help reduce unnecessary spending and improve healthcare value.

With such concerted efforts to increase utilization of generic drugs, physicians who want a patient to use a specific brand-name drug must be both vigilant and persistent. Educating patients so they can be their own advocates is important.

EXPLAIN THE DIFFERENCES

Many patients are accustomed to using generic systemic drugs, such as antihypertensives and statins, without problems, says Keith A. Walter, MD, professor of ophthalmology at Wake Forest University School of Medicine in Winston-Salem, N.C. That is why they need to be educated about the differences that exist with branded and generic ophthalmic drugs.

“You have to talk to your patients,” Dr. Walter says. “It doesn’t take more than 30 seconds of chair time. Once patients understand the consequences — for a corneal transplant, for example, a less efficacious drug could mean graft rejection — they will fight the battle with the pharmacy and the insurance carrier.”

Dr. Walter believes this type of patient education is most effective coming from the doctor, but it’s essential that staff members also support his philosophy.

PRESENT THE EVIDENCE TO INSURERS

Even when patients understand and advocate for a brand-name drug at the pharmacy, they may encounter a barrier with their insurance carriers. Dr. Walter has prepared a form letter for these situations and includes supporting documentation from the literature. In the case of a drug he’s prescribing post corneal transplant, he also emphasizes the economic consequences. “I suggest the insurer may prefer to pay for a drop that costs $100 or $150 rather than a new transplant, which will cost $30,000,” he says. “Once I tell them that, they usually approve the drug.”

DELIVER A CONSISTENT MESSAGE EFFICIENTLY

Gregg J. Berdy, MD, an assistant professor of clinical ophthalmology at Washington University School of Medicine and in private practice at Ophthalmology Associates in St. Louis, used to educate patients one-on-one. Today, patients view a 30-minute video about their upcoming surgery in which he describes risks and complications along with the reasons why he is prescribing specific drugs for them. “I explain why I think it’s important for them to use the branded drugs I prescribe,” he says. “I also tell them if they can’t afford a drug, they should let us know, so we can do something about it.”

The videos, along with handouts about specific procedures, ensure that all pre-op patients receive the same information and it is disseminated efficiently.

HAVE PATIENTS BRING IN THEIR BOTTLES

Generic substitution can occur unexpectedly, says Robert D. Fechtner, MD, professor and director of the glaucoma division of UMDNJ-New Jersey Medical School in Newark. “I never know when I write a prescription if it’s on formulary,” he says. “And every January, there’s a chance that patients whose IOPs were successfully controlled on a particular medication will need to change because their insurance carrier has a new formulary. It’s really confusing for patients. That’s why I think it’s more important than ever that patients bring their eyedrop bottles with them to their appointments, so I can see what they’re getting.”

Inform Patients About Assistance Programs

Patients who are unable to afford their prescription medications may be able to take advantage of assistance programs offered by several nonprofit organizations and some pharmaceutical companies (See “Patient Assistance Programs” on Page 21). In fact, according to Dr. Walter, through these programs, some branded drugs become more affordable than their generic counterparts. ◆

References