The Future of BRANDED VS. GENERIC

Forecasting trends and innovations that will affect prescribing

The landscape of both branded and generic medications is constantly changing. We asked physicians what trends they see shaping the future, as well as which new branded and generic medications they most look forward to seeing released.

Eric D. Donnenfeld, MD, FAAO: My cataract and refractive patients generally appreciate quality and want premium, branded pharmaceuticals. I’m hoping that we will continue to see innovation in ophthalmic medications, and new options will become available. I think we will also see better delivery systems for long-term medication, such as intracameral injections and punctal plugs.

Mitchell A. Jackson, MD: The trend in cataract surgery is moving more of us toward a dropless approach with intravitreal injections. I used this approach for a while, but it is not without risk. It can complicate an uncomplicated surgery, and it takes away the “wow” factor because patients have floaters for a few days. Another advance is a selection of combination generics from Imprimis that lets patients use fewer drops. I’m also looking forward to seeing intracameral moxifloxacin or intracameral moxifloxacin/dexamethasone for surgical patients and a new punctal plug containing a steroid (Dextenza, Ocular Therapeutix).

John A. Hovanesian, MD, FACS: I see some encouraging trends — for example, BromSite (bromfenac ophthalmic solution 0.075%) from Sun Pharmaceuticals. This may be a more responsible type of medication that we can feel safer prescribing, although we cannot expect a major cost savings. This is one of many positive indications I see that drug companies understand what physicians want.

Michael Harris, MD: I think we will see better generic drugs in the future. With current generics, patients may pay less, but they also get less. I would prefer to see generic drugs that are identical, rather than “equivalent.” On the practical side, prices have to be curtailed. I would prefer that the FDA rush to approve additional generics that currently have no other generic competition. In some cases, the $80 generic replacement for a $100 branded drug is still too expensive for our patients. More competition for market share between generic companies would bring the generic costs down and possibly even bring down the brand name costs, giving consumers a real choice. Today, the major companies that produce brand name drugs also make generic versions; without generic competition, they have a monopoly on pricing.

Francis Mah, MD: With drug companies, clinicians, and patients all feeling a great deal of pressure, there is a new, burgeoning industry of com-pounding pharmacies that provide first-line medications. At the same time, there is a push back for traditional development of novel medications that support paying the cost of a branded drug. Ithink we will also see drug companies move toward the development of unique delivery methods or devices. By combining a drug and a new delivery method, they move from drug plan reimbursements to reimbursements for medical procedures. When patients can have a procedure covered by insurance instead of purchasing and instilling drops several times per day, there have the potential for less financial stress and better clinical outcomes. At the same time, physicians gain a billable procedure and avoid the choice between cost and efficacy. ■