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Comment & Response
October 2016

Prescription Trends—Brand-Name Drugs vs Generic—Reply

Author Affiliations
  • 1Program On Regulation, Therapeutics, And Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston
JAMA Intern Med. 2016;176(10):1574-1575. doi:10.1001/jamainternmed.2016.5378

In Reply Use of low-cost, bioequivalent generic drugs in place of brand-name drugs has been shown to facilitate patient adherence to essential medications, as well as to lead to improved patient health outcomes. In response to our survey1 showing that a substantial minority of physicians still qualify as generic skeptics owing to concern about the safety, efficacy, or adverse effects of generic drugs and report that they will at least occasionally request that a patient receive a brand-name drug when a generic is available, Chee and colleagues outline some features of the pharmaceutical marketplace that could account for these results. First, they correctly point out that brand-name manufacturers’ marketing strategies undermine faith in generic drugs both directly and indirectly; for example, as atorvastatin (Lipitor; Pfizer) was coming off patent, Pfizer ran advertisements specifically promoting trust in its product over potential generics.2 However, manufacturers of bioequivalent generic versions generally do not promote their products in response because any revenues spent on marketing would increase the cost of production, and the drugs are treated as interchangeable at the pharmacy level. Concerned about the messages being transmitted to their physicians in the course of routine marketing interactions with brand-name drug representatives, some individual institutions have imposed restrictions on drug marketers’ access to physicians, contributing to changes in prescribing practices favoring generic drugs.3 While we support the proposal by Chee and colleagues to identify physicians’ informational needs in this area and try to address them, a grassroots or public marketing effort relating to generic drugs alone may not effectively counterweight the $30 to $60 billion spent annually by brand-name manufacturers in this area.4

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