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Dr Riyad Fares

Generic prescribing - An ever-changing landscape

Riyad Fares, M.D., LHP medical director

Physicians often have many choices when it comes to prescribing medications to treat basic conditions. Nearly 70% of Americans are taking at least one prescription drug and more than half take two, according to Mayo Clinic and Olmsted Medical Center. Twenty percent of Americans use at least five prescription medications.

Generic medication prescribing remains one of the key strategies to delivering high value and quality care to our patients. Legacy Health Partners will be tracking generic medication prescriptions as a clinical integration measure, which is applicable to all providers and specialties. Through the analysis of claims data, select medications including antihyperlipidemics (statins), antihypertensives (beta-blockers, ACEi, ARB, calcium channel blockers) and mental health medications (antidepressants and antipsychotics) will be monitored and reported back to providers at a network level.

Market factors create waste, drive costs upward

As prescribers, we should be familiar with those market factors that may be affecting the compliance of our patients and creating waste for the system. Rapidly shifting dynamics in the pharmaceutical marketplace are creating strain on the delivery of care. 

Three big pharmaceutical companies now control 40% of the generic market. Between 2002 and 2013, the number of manufacturers making oral digoxin, fell from eight to three, and the cost increased by 637 percent. Humulin R U-500 has increased 325% from 2010 to 2015. Large multinational pharmaceutical companies may use deep pockets to stall generic manufacturers from producing generic drugs. Most notably this occurred when clopridogel (Plavix) went off patent in 2012. Bristol-Myers Squibb and Sanofi’s management agreed to pay Apotex, a Canadian generic drug manufacturer, tens of millions of dollars not to enter the market. Additionally, pharmaceutical companies may be repackaging generics under different brand names and marketing heavily to patients. Duexis purports to ease side effects of NSAID induced dyspepsia by combining two medications: ibuprofen and famotidine (Pepcid). A 30-day supply (90 tablets) can cost over $1,400. (Source reference.)

Impacting what we can
Medication costs are draining the resources of healthcare at a faster rate than ever. Whether you are a cardiologist considering the newest anti-platelet or a dermatologist who is struggling with the sudden increase in the cost of doxycycline, it is our responsibility to use our keen judgment and clinical knowledge to educate and guide or patients toward generic medications and evidence-based therapeutics. 

Note: Generic medication prescribing rate is one of the LHP 2016 clinical integration performance measures.

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