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 A large portion of that was spent by patients, the researchers
found.
"Prescription drug prescribing during the time of this paper was not
efficient and still isn’t efficient," said lead author Dr. Michael
Johansen, of Ohio State University in Columbus. "The number we’re
spending on prescription drugs is really large. At least from what
this paper shows, patients are bearing a disproportionate amount of
the inefficiencies in our prescribing."
One way to make prescribing more efficient is to order less
expensive generic drugs to take the place of brand name medications.
For example, instead of prescribing AstraZeneca's Crestor, a statin
drug for lowering high cholesterol, doctors might prescribe
rosuvastatin, which is the less expensive generic form of Crestor.
Another, less widely accepted approach is known as therapeutic
substitution. With therapeutic substitution, the patient would still
receive a statin drug, but maybe not the same one he was taking
before. He might receive atorvastatin, for example, which is the
generic form of Pfizer's Lipitor. Or he might receive simvastatin,
the generic form of Merck's Zocor. The patient would receive the
least expensive drug in the same class of medications.
To see how much could possibly be saved with therapeutic
substitution, Johansen and his co-author Dr. Caroline Richardson of
the University of Michigan in Ann Arbor analyzed 2010-2012 data on
107,132 medication users.
As reported in JAMA Internal Medicine, about 62 percent of
participants reported using prescription drugs, and about a third
were using a medication that was eligible for therapeutic
substitution.
Of the $760 billion spent on prescription drugs during the study
period, about $73 billion may have been unnecessarily spent on brand
name drugs, the researchers found.
And nearly $25 billion of the $175 billion that patients paid
out-of-pocket for their drugs during that time might have been saved
by therapeutic substitutions.
The key to moving toward therapeutic substitution is to coordinate
with doctors, said Johansen.
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It might be the case, he said, that a patient needs to take a
specific generic drug for a specific reason.
His concerns are echoed in an editorial by Dr. Joseph Ross, JAMA
Internal Medicine associate editor and associate professor at Yale
University in New Haven, Connecticut.
"To achieve the benefits of within-class substitution, we need wider
adoption of systematic protocols, aligned with physician judgment,
as to when such substitutions are beneficial and when not," he
wrote.
Johansen thinks it will take a lot of different interventions at
different levels to overcome reluctance to implement therapeutic
substitution, but policy efforts will probably be helpful.
"Essentially the feeling you get with this is very similar to how
people felt when generics were coming out," he said. But, he pointed
out, "The acceptance of generic drugs has improved."
SOURCE: http://bit.ly/23CWQAm and http://bit.ly/1rDtzcP JAMA
Internal Medicine, online May 9, 2016.
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