Brand vs Generic Drugs... What Serves the Profession and Patient?

Drug shortages are rising expenditures warrant a look at the role of pharmaceutical companies and generic manufactures in today's health care landscape.

I recently attended the National Association of Chain Drug Stores (NACDS) Pharmacy & Technology meeting in Boston. It was held when Hurricane Irene decided to visit the Northeast United States. As usual, the meeting was informative even if attendance was reduced. It was with great pleasure that I participated in the 2011 Next-Generation Pharmacist^TM Awards ceremony, a program jointly created by Pharmacy Times and Parata Systems, which was held at the JFK Presidential Library and Museum during the meeting. What an exciting program! There are many great pharmacists in our profession—and being able to honor some of them is truly rewarding. I do hope you will consider nominating a colleague or yourself next year for the 2012 awards (go to www.nextgenerationpharmacist.com for updates).

At the meeting’s exhibit program, I was struck by how many generic drug companies were there in comparison to the number of pharma companies. Is pharmacy as a profession better served when researchintensive pharmaceutical companies are strong and dominant? Or does the growth in generic drug utilization, now approaching 80% of prescriptions dispensed, serve the profession and patients better? With several blockbuster drugs coming off patent recently and in the next few years, this figure will approach 85% by 2016.

One pharma company recently announced that they expected to cut 13,000 more jobs as drug patents expire. So if you are employed in this sector you would find the rise in generic drugs usage problematic. As a patient or an agency that pays for prescription drugs you might be excited by the increased availability and usage of generic drugs. However, that excitement might lead to discouragement as you review the National Health Spending Projections.

Prescription drug expenditures will double in the next 10 years to $512.6 billion by 2020, which represents an annual spending growth rate of 7.1%. This will mean that prescription drug spending is projected to be 11.1% of National Health Expenditures, suggesting that more attention will be focused on drug costs in the future. We are already seeing pressures being applied by both payers and governmental agencies to require that superior effectiveness over existing drugs be shown before new drugs are placed on formulary or payment is provided. This suggests that we may see fewer blockbuster drugs in the future because of an increasing focus on comparative effectiveness, among other reasons.

Drug shortages have become a critical problem for prescribers, pharmacists, and patients recently. There are many reasons for this problem. What role does the drug manufacturer play in solving it? Many of the problem drugs are generic compounds, so the generic drug companies play an important role in solving this problem. Will having stronger generic drug manufacturers lead to a minimization of these shortages—or has the problem increased recently because generic drug producers do not appreciate their societal obligation to make sure drugs are available?

Several recent reports suggest that things may be improving for pharma companies. Drug approvals are up in 2011. A revamped research approach that includes developing and testing combination therapy earlier and using pharmacogenetics to more accurately assess drug effectiveness are offered as reasons for why drug approvals are up.

This brings me back to the question I pondered after looking at the makeup of the exhibits at the NACDS meeting—is the profession better served when there are strong pharmaceutical companies engaged in research to discover and bring new drug products to market? If pharmaceutical care is centered on pharmaceuticals, then it might be suggested that having “new” pharmaceuticals will make things better for pharmacy. However, if current drugs are not being used well— and much evidence supports this observation—just adding new drugs to the marketplace will not help advance the pharmacy profession. Is a strong pharmaceutical industry necessary to assure the development of new agents to offer new treatment options for conditions that are not effectively managed? Patients experiencing such conditions would answer “yes.” Pharmacists wanting to help those patients would agree.

It has been suggested that the mission of the pharmacist is to assure that medication outcomes are achieved. This cannot be accomplished by the pharmacist alone, but only through collaboration. One partner in this effort should be the pharmaceutical manufacturer. When pharma manufacturers are strong and are committed to collaboration with pharmacists, then the pharmacy profession is better served. Strong generic drug companies with the same commitment can also help advance pharmacy as a profession. Both patients and pharmacists are better served when there is a strong pharmaceutical industry working collaboratively with pharmacists to help patients make the best use of their medications. Both brand and generic drug companies are important. I think pharmacy, pharmacists, and patients are better served when both are strong. PT

Mr. Eckel is a professor at the Eshelman School of Pharmacy, University of North Carolina at Chapel Hill. He serves as executive director of the North Carolina Association of Pharmacists.