Street Smarts

What's in a Name?

When a generic equivalent will work just as well, what's the motivation for doctors to insist on a particular brand?

By Dan Beck, OD
Leland, N.C.

Even though generic options exist, many doctors continue to prescribe more expensive branded alternatives. Unfortunately, I have seen this time and again.

Costly "Infection"

I recently examined a college student for red-eye follow up. Her hometown optometrist had examined and treated her a few days before she came to me. She'd returned to school, several hours away from home, and needed someone in the area to conduct a follow-up exam. Her records said she had unspecified conjunctivitis with no corneal involvement. Her "infection" had completely resolved. Although she was happy her condition had cleared, she mentioned the very high cost of the drops she was prescribed. They were the latest fluoroquinolone topical. Even with insurance, her copay was $50. Considering there was no corneal involvement, cheaper options should have been considered. Even with no insurance, generic ciprofloxacin would have cost her less than $20.

Overpriced Brand-name Drugs

Another patient came in for a cataract post-op exam. His surgeon prescribed Pred Forte, Zymar and Acuvail. With the possible exception of Zymar, the patient could have been treated just as effectively with generic medications, such as prednisolone and ketorolac. In my opinion, he overpaid by about $100.

Why Push Branded Products?

Why do so many doctors prescribe medications with little or no regard to patient cost? What's in it for them? From what I can see, nothing. Current laws forbid pharmaceutical companies from compensating doctors who prescribe their drugs. Even little "freebies," such as pens bearing a drug name, are no longer allowed, and the days of "wooing" physicians with tickets for major sports events or expensive dinners are long gone.

Aside from possibly laziness, I think it comes down to ego. Some doctors feel compelled to use the newest medications, and most pontificate about that fact when asked. Their already inflated self-opinions are further ballooned by drug reps who stroke the egos of doctors who use their drugs. Nothing jacks these doctors up more than a rep telling them they write more scripts for their drugs than anyone else in the territory. These doctors are so full of themselves that they don't even see that the only ones benefiting are the reps and the pharma companies.

The Way I See It

Don't kid yourself. Pharma sales reps are no different than drug dealers. Actually, they're worse in my opinion. An illegal drug dealer won't continue to visit you if you don't buy his product. You say no, he leaves you alone. Most drug reps will call on you endlessly until you agree to prescribe their drugs.

I'm not saying we should always prescribe the cheapest option. Most new medications are, indeed, more effective than their predecessors and are welcome weapons against disease. But the latest and greatest drug doesn't always have to be the first option.

The physical and mental health of your patients should be your top priority — but their financial health should be a close second. Don't force them to spend more than is necessary for medication. Even if they don't say it out loud, they'll thank you for it. nOD