Patients Are Less Likely to Buy Generics After Receiving Bad News About Their Health

Patients who recieve bad news about their health may be less inclined to purchase generic drugs, according to the results of a Johns Hopkins University study published recently in the Journal of Marketing.¹ The bad news effect could result in 3% more total drug expenditures per patient.²

Most specialists agree that generic drugs have the same therapeutic value as brand name medications, yet generics can cost 80% to 85% less than their branded counterparts, according to study authors Andrew Ching, PhD, a professor of marketing, economics, and health, and Manuel Hermosilla, PhD, an assistant professor of marketing, at Johns Hopkins Carey Business School in Baltimore, Maryland.²

Patients may consider brand name drugs to be more effec-tive and safer, but choosing cheaper generic medications could save the US health system an estimated $36 billion annually, according to the investigators.²

Ching and Hermosilla undertook the study to understand how medical-related insecurities, such as receiving bad medical news, affect a patient’s choice of brand versus generic treatment options.²

They focused on low-density lipoprotein (LDL) cholesterol levels taken from a blood test, particularly on the clinically defined borderline (“frontier”) range between near optimal and borderline high (between 129 mg/dL and 130 mg/dL).²

Although the cut-off level as it related to bad news was 130 mg/dL, it did not mean the individual was systematically less healthy.

There is a significant margin of error in measuring LDL, so the blood test was a good means of understanding how bad news affected patient behavior.²

After collecting the samples and informing patients of their cholesterol levels, the investigators observed that those who received a borderline high result (bad news) were 1.3% less likely than control patients to choose a generic medication.

However, given the ratio of generic to brand name drugs in the market, this could translate to an 8% higher willingness to buy brand name drugs.²

Bad news was also more likely to impact drug selection within the first 90 days of receiving the news.

The front-loading effect notably occurred in patients who bought a drug for the first time, discussed LDL test results during a medical office visit, or were healthier and surprised by the bad news.²

The Johns Hopkins team conducted another, simi-lar study in which they analyzed drug claims made by patients with hemoglobin A1_c levels between the 6.9% to 7% threshold, which indicates diabetes, and made similar observations.

Patients who received bad news—in this case learning they had diabetes—had more medical-related insecurity and an increased likelihood of choosing a brand name medication.²

Patients may choose the brand name drug over the gener-ic because it is likely to be older. In Canada and the United States, it takes approximately 10 years for a generic to enter markets after the brand name has been made available, during which time the branded drug can build up clout.³

Data from a 2020 study looking at how the perceived age of an agent influences drug selection support this idea. “Although there is a small segment of the population that chooses the newer [generic], believing it to be of greater efficacy, most consumers believe that an older drug is both safer and more efficacious,” investigators wrote.

In another study, from 2022, investigators manipulated a timeline of the development of the COVID-19 vaccine. They observed that more individuals supported the vaccine if they thought the technology had existed for longer than was actually the case.³

Patients may not choose generic drugs because they are not familiar with them; some study results suggest that 33% do not understand why generic drugs even exist.³

Education could be as simple as sending a text to remind patients that generic drugs are therapeutically equivalent to brand name medications, Hermosilla suggested.² Insurers and policy makers could also implement policies incentivizing the use of generics.¹

The latest study data show that bad medical results can trigger behavioral responses that impact health systems.

More research that includes patients’ routine tests or diagnostics could increase understanding about how patient decision-making and spending affect the health system.²