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Editor's Note
Feb 11, 2013

Systems-Level Interventions to Improve Value in Prescription Medication UseComment on “Physician Acquiescence to Patient Demands for Brand-Name Drugs”

JAMA Intern Med. 2013;173(3):239. doi:10.1001/jamainternmed.2013.3583

There is immense excess cost associated with using brand-name drugs when equally efficacious generics are available. For unclear reasons, a large proportion of physicians are reluctant to opt for the more cost-effective choices, especially if patients request brand-name drugs. Campbell et al find that social factors appear to influence medication decisions. Such situations call for systems-level interventions to overcome the irrational cultural practices. In this case, large, closed health systems with pharmacy benefits and managed formularies use pharmacy-level decision making on drugs, once the physician has made the decision on the appropriateness of the medication. These systems also allow for physician override when appropriate. Such systems-level interventions have immense potential to increase value in prescription medication use.

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