Many Doctors Prescribe Brand-Name Drugs at Patient Request

Physicians who had been in practice longer, who practiced certain specialties, and who had certain types of contact with industry representatives were more likely to heed patient requests, according to analysis of a national survey.

More than one-third of physicians in a national survey acknowledged that they sometimes or often go along with patient requests for a brand-name prescription drug even when a generic alternative is available, according to an analysis of the survey results published online on January 7, 2013, in JAMA Internal Medicine.

The survey, conducted in 2009, included 1891 physicians in 7 specialties. Overall, the analysis found that 37% of physicians said they sometimes or often agreed to prescribe a brand-name drug at their patients’ request. However, physicians who had been in practice longer, physicians in certain specialties, and physicians who had certain kinds of contact with drug industry representatives were significantly more likely to give in to their patients’ desires.

Of physicians who had been in practice for at least 30 years, 43% gave in to patient demand, compared with 31% of physicians who had been in practice for at most 10 years. The portion of physicians who gave in to patient desires ranged widely by specialty: pediatrics (17%), anesthesiology (26%), cardiology (44%), and general surgery (20%). Physicians in all these specialties were significantly less likely to give in to patient requests than were internal medicine physicians (50%).

Physicians who received free food or beverages in their offices from pharmaceutical industry representatives were significantly more likely to give in to patient demands than those who did not (39% vs. 33%), as were physicians who received drug samples compared with those who did not (40% vs. 31%). In addition, physicians who sometimes or often met with drug industry representatives to stay up to date were significantly more likely to give in to patient requests than those who did not (40% vs. 34%). The association between efforts undertaken by industry representatives and the likelihood of physicians acceding to their patients’ preference for brand-name medications suggests that these activities play a successful marketing role for pharmaceutical companies.

The researchers note that the practice of prescribing brand-name medications when a generic alternative is available adds significant costs to the health care system. They add that interventions that can combat this practice include implementing a closed health system such as the Veterans Health Administration, in which the pharmacy has primary control over the choice between brand-name and generic drugs. Alternatively, hospitals or health systems could require drug samples to be given to the pharmacy or another central repository rather than to individual physicians.

“The JAMA Internal Medicine study demonstrates that we are still leaving savings on the table that could be achieved by increasing the use of generic drugs,” said Generic Pharmaceutical Association President and CEO Ralph G. Neas in a press release. “The use of safe and effective generic versions of brand-name drugs currently saves consumers and the US health care system $1 billion every other day, a total of $192 billion in 2011. But, as significant as these savings are, there still is room for improvement and we must realize that generics are part of the solution to sustaining affordable health care in America.”