Permit me to share some personal information – my eldest son has epilepsy. The good news is that his condition is under control due to the wonders of modern medicine. For that reason, today’s Good Morning America segment on generic drug substitution (minus patient and physician knowledge or consent) hit a particularly resonant chord.
Here’s how GMA began its report:
"Imagine going to the pharmacy to fill your prescription only to learn later that the drug your doctor prescribed is not the one you received. The prescription was switched without your knowledge or permission. Pharmacies could be switching your drugs without your knowledge. Not just switched to a generic version of the prescribed drug, but to a different drug altogether. That is exactly what happened to Amy Detrick, who said her pharmacist switched her epilepsy medication without her permission.”
The report also interviews Sally Greenberg, executive director of the National Consumers League, "We believe that if a patient is switched from one drug to another, that it should not be legal unless the patient and the doctor have been informed and are on board with the switch."
(The complete Good Morning America segment can be found here.)
In October 2008, National Consumers League released a survey of 1,035 prescription drug users on therapeutic substitution issues this morning. The survey was conducted by Harris Interactive. Full results and additional materials are online at www.nclnet.org/health/switching/ and the press release is at http://www.nclnet.org/news/2008/therapeutic_substitution_10012008.htm.
Key data points include:
- Respondents very much oppose health insurance companies providing incentives to pharmacists (55%) or physicians (55%) for switching patients to lower cost alternatives to medications.
- Vast majorities of respondents (78%) very much favor an explicit requirement to consult the physician before any and all therapeutic substitution takes place.
- Vast majorities of respondents (85%) very much favor a requirement that patients always be notified if their prescription is changed.
- A large majority of the general population are not sure if there is a law in their state that regulates therapeutic substitution (90% of the Rx users), but 50% of Rx users somewhat or very much favor legislation.
Patient Awareness of Therapeutic Switching is Low, but Patients Believe it is Happening
- As expected, awareness of the concept of therapeutic substitution – and the difference with generic substitution – is low.
– 2 of 3 prescription users are unaware therapeutic substitution
– Only 1 in 4 prescription users are unaware that therapeutic substitution involves replacing the prescribed drug with a chemically different one
- The vast majority of Rx users think that therapeutic substitution occurs at least sometimes in the
Switching Doesn’t Always Result in Positive Outcomes
- 15% of general Rx users saying that they or a family member experienced therapeutic substitution
– Nearly half of Rx users (47%) were dissatisfied (or their family was) with how the process occurred and report that this substitution did not result in lower pocket costs.
– More than a third (40%) said that the new medication was not as effective as the original one, and nearly a third (30%) experienced more side-effects following the substitution.
– Large majorities of Rx users think that the potential side effects of the new medication, the patient’s medical history, how well the drug works and the prescribing physician's opinion are factors that are absolutely essential when decisions are made about therapeutic substitution.
Just as no two patients have the same biochemistry, no two medicines are exactly equivalent. But if your primary goal is to reduce short-term costs, that's an inconvenient truth.
I am a big believer in FDA-approved generic drugs. They are safe and effective and represent an enormous opportunity for health care savings. I applaud insurance company programs that seek to educate consumers about them. However, I am a bigger opponent of forced switching. Disempowering physicians and patients results in bad outcomes.
The repercussions of choosing short-term thinking over long-term results, of short-term cost-based choices over patient-based care, of “me-too” medicines over the right medicine for the right patient at the right time—are pernicious to both the public purse as well as the public health.
