Imminent Influx of Generic COPD Inhalers Will Require Pharmacist Input

A host of new inhalers for chronic obstructive pulmonary disease (COPD) are nearing market entry.

Some of these inhalers are generics that will probably cost less than current brand name-only products.

Outside the United States, a generic product may be delivered with a dissimilar device (eg, metered-dose inhaler versus dry-powder inhaler). In the United States, however, the FDA requires manufacturers to demonstrate equivalent delivery to the lungs and systemic exposure. Manufacturers must also demonstrate that the new device is equivalent to both generic and branded products.

Now, an article published in the International Journal of COPD has detailed the impact of switching products in terms of cost and adherence.

Proper technique training—a key component of a strong patient-provider relationship—is crucial to preventing poor clinical outcomes and increased use of health care resources.

All of the inhaled products are equally effective when used correctly, but different inhaler types are best for certain patients. Switching branded products for generic equivalents produces direct prescription savings, but the indirect cost of nonadherence-induced disease worsening can greatly outweigh these benefits.

Unintentional medication nonadherence is driven by poor inhaler handling technique, critical handling errors, inability to recall consultations, and environmental constraints.

Patient preference for a device is critical for adherence because patients are less likely to unilaterally discontinue the therapy. The patient should take part in deciding to switch to a generic, or at least be aware of the switch, to provide an opportunity to inquire about proper technique.

One factor that seems to create confusion is when the prescribers do not specify a specific inhaler on the prescription. The study authors urged pharmacists to consult with patients and prescribers before filling these prescriptions.

Communication is imperative across the patient, prescriber, and pharmacist to ensure all members of the care team are aware of the switch to a generic product. All parties should monitor patients’ adherence to devices to avoid indirect costs such as hospitalization that can outweigh cost savings on a population-wide level.