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Battle over generic
Pfizer, for example, has been pouring millions of dollars into marketing its drugs leaves
cholesterol-lowering Lipitor since the drug's patent protection expired in November — doctors, drug
the latest example of how pharmaceutical giants try to keep brand names in the companies at odds
Consumers, experts say, often mistakenly believe that generics are dime-store The desktop computer in Dr. Louis Papa's knock-offs — not the real deal. In fact, Brighton office is equipped with software brand names and their generic alternatives that has become part of a community effort generics are often much cheaper — locally — because they do not come with a hefty When Papa types in the name of a patient, a chart showing the patient's history flashes development costs have already been on the screen — with a category in which "Generics conjure up the image of low quality. That's not the case," said Dr. Aaron The appearance of a green smiley face on Seth Kesselheim, a Harvard Medical School assistant professor who has examined the selection of a generic drug is putting him tactics used by pharmaceutical giants to delay the entry of generic alternatives. But if a red frownie face pops up, it might be because he has chosen a brand-name drug when a cheaper generic will likely work just as well. A smiley face, however, isn't enough to make dramatic changes in the drug-use habits of the American public. Although the nation has been moving toward greater use of generic drugs, progress has been slowed by the profit- minded pharmaceutical industry and a public that is slow to abandon old habits. Format Dynamics :: CleanPrint ::
Using generic drugs is one thing that the doctors under the umbrella of the URMC. public can do to help control skyrocketing health care costs, even though the financial — although that can require the doctor returns are not easily discernible because getting prior approval from the insurer. insurance rates have not declined, here or elsewhere. Prescription drugs account for about 10 percent of the nation's almost $3 trillion-a-year health care bill, with new Chris Wiest, vice president of public policy for the Rochester Business Alliance, said market and driving up the total spent on "Consumers don't see ads on TV or in In the Rochester area, generic drugs now newspapers for generic drugs," Wiest said. "Instead, they're being told to go to their average. Each percentage point increase in name." generics chops off about $30 million from Generic checks
Excellus BlueCross BlueShield, the largest Under federal law, a brand-name drug has Consumers have plenty of reasons to turn active ingredients as the original drug. A Dr. Bob Panzer, chief quality officer of the said patients are far more likely to purchase generics because of their affordability and then to take the drugs longer. They also are safer than new brands because their ingredients have stood the t est of time, noted Dr. Sidney Wolfe, director of Public Citizen's Health Research Group. Nothing binds Papa to prescribe what is recommended by the software on his computer and those of about 650 other Format Dynamics :: CleanPrint ::
"It's just hard to know how to jump through quickly," said Trilby deJung, a health law generic competitors, who need to show that attorney with the Rochester-based Empire their products are just as effective as the Pharmacists find themselves caught in the One wrinkle in the federal law: Usually only version for the first six months after a "The patient comes to us expecting that if a patent expires — giving the pharmaceutical doctor wants a prescription, we will be able company a leg up in seizing market share. to fill it. We find out that the patient can't authorization," said Nadia Sefein, president State law is also helping prescriptions move of the Pharmacy Society of Rochester. toward generics. Lakeville Pharmacy in Livingston County, prescriptions with a generic drug unless the tells of the seemingly endless phone tag — doctor writes DAW — dispense as written with calls from patients inquiring about the status of the prescriptions and pharmacists Insurers can demand prior authorization in any event — requiring the doctor to make a case for the more expensive drug and "It's called the hassle factor," said Dr. Peter sometimes show that the drug preferred by Deane, a local allergist and rheumatologist. Medicaid recipients are governed by other rules. Brand-name drugs that have generic equivalents are not covered unless prior authorization from the state Health Department or the insurer is obtained. But the law provides for exceptions, and numerous brand names have been exempted from such authorization. In October, management of most Medicaid recipients' drug benefits was put in the hands of private insurers, which could result in even fewer brand names being prescribed. Format Dynamics :: CleanPrint ::
Promoting smiles
Danbury, Conn., which bases its estimate The smiley and frownie faces are part of a The other local hospital systems are also considers use of generics one of several hospitals for efficiencies and effectiveness. physicians and insurance companies to find ways to improve the quality of care and faces but red (stop) and green (go) bars. "Each year we ask our member companies hampering their ability to succeed," said RBA President Sandy Parker. "Each year automatically unless there is no generic or they tell us it's escalating health care costs." the physician specifically requests a brand Cost of brands
Excellus has seen the use of generics rise from 56 percent of all prescriptions filled in average nationwide are expected to go up by 8.5 percent this year. Locally, average MVP Health Care reports similar results, from 59 percent in 2005 to 76 percent in 2011. Such improvement, said Excellus, accounted for savings of $31 million in the Finger Lakes region in 2010 and $127 million in the 39-county upstate area. Nationally, 78 percent of the prescriptions filled in 2010 were generic, according to t he IMS Institute for Healthcare Informatics, a health care research company based in Format Dynamics :: CleanPrint ::
annual increases have been near or above president for MVP. Pharma resists
Dozens of brand drugs have recently lost protections. In theory, this should make Nationally, generics make up about three- quarters of prescriptions filled, while brand names account for about three-quarters of companies are at risk of losing as much as the money spent on prescription drugs — with the total spent growing to $307 billion "This is a very important time for health the cost of all the research needed to bring generics," said Wells Wilkinson, staff the drug to market. They estimate that it costs about $1 billion — a figure critics say is overblown — to get a drug on pharmacy shelves, a cost that they then must recoup. Drugs for difficult-to-treat diseases, such "We will continue to make our medicines Approximately 7,000 people in upstate New York take prescription drugs to treat multiple sclerosis, for example. Each of the six FDA-approved drugs for treating MS costs more than $3,000 a month. The wholesale cost for a 52-week supply of Copaxone was $47,190 in 2010. "By 2020, 40 percent of the money spent on prescriptions will be due to these high- cost specialty drugs. Now it's 15 percent," said Jim Hopsicker, pharmacy vice Format Dynamics :: CleanPrint ::
available post loss of exclusivity, providing pharmacies saying that atorvastatin — the patients the ability to remain on the brand generic alternative to Lipitor — would not that they and their doctor have chosen," Instead, the notice says, Lipitor can be such marketing tools as co-pay coupons to dispensed to consumers in these plans and they will pay the same out-of-pocket co- Such discounts create the illusion of big the consumer portion of the cost, but the biggest health insurer in the region, say employer portion of the bill is not lowered. they are not going along with any offers to Mixed signals
Association says that the increased use of Confusion among patients is likely aiding coupons by drug companies could raise the the pharmaceutical companies. nation's health care costs by $32 billion When Lipitor, the nation's most prescribed drug, recently went off patent, pharmacies Pharmaceutical companies also continue to and insurers were left in a cloud of dispatch sales representatives to doctors' uncertainty over its cost and how it would It was a guessing game for Al Fisher, 69, of Brockport, described pharmaceutical sales as the profession with the best-looking bunch of people next to actors. And, he said, brand-name drugs — not even a drug company's own generic equivalent — are what they bring to his office. Consumer advocates and legal experts also question whether deals are being cut to forestall generic competition. Consider that CVS Caremark, which works with insurance companies to fill prescriptions, sent out a notice to Format Dynamics :: CleanPrint ::
As the expiration date approached, Fisher called his insurer, MVP, four times to find out what to expect. He got four different answers. Would he get atorvastatin or Lipitor when he picked up his month's supply for December at the Faris Pharmacy in Greece? Fisher stuck with Lipitor because, under his MVP plan at the time, Lipitor cost him $10 less than atorvastatin. His January refill, however, was with atorvastatin, which by then was $37 cheaper than Lipitor. "I'm going to live happily ever after," Fisher said. Such variations in price, while puzzling, are typical when a drug goes off patent. The Business Alliance's Wiest notes the importance of an informed citizenry. "Consumers need to be actively engaged in managing their own health and to look at alternatives to more expensive options that are just as effective," he said. "With ever- spiraling and escalating health care costs, we have to look at where those costs are coming from, and name-brand drugs are a huge component of those costs."


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