When doctors prescribe brand-name drugs over generics, the taxpayers foot the bill

Far too many doctors in the U.S. prescribe brand-name drugs when generics can be dramatically cheaper.

Far too many doctors in the U.S. prescribe brand-name drugs when generics can be dramatically cheaper. When it comes to lower-income Medicare patients, it can be the taxpayer who covers the difference in price -- up to hundreds of millions of dollars a year. ProPublica senior reporter Tracy Weber has been gathering data about the cost of prescription drugs to the taxpayer, and tells Marketplace Morning Report host David Brancaccio what she found.

"Medicare has a massive prescription drug program called Part D. It issues one in  four prescriptions written in the country every year, and we took a look at the money involved. And we noticed that some doctors were outliers. They were prescribing way more expensively than their peers -- just a small group of these doctors, 900 doctors, were prescribing $1 billion worth of drugs a year. And when we looked closer at these doctors, they had huge percentages of brand name drugs. So while their peers were prescribing 75 percent generics, they were prescribing mostly brand name drugs. We figured out that if those doctors prescribed like their peers, Medicare, every year, could save $300 million just on those doctors."

But why would doctors purposefully prescribe a name-brand over a less expensive, but just as effective, generic?

"What we found when we mapped out over the country is there's pockets of doctors who are all prescribing high levels of brand-name drugs, so we went out and talked with these doctors. And, many of them feel, first of all, that the brand-name work better. And many of them, their practices are almost entirely made up of people who are receiving the low-income subsidy. So not only do they not have an incentive, but they believe that the drugs they're prescribing are better."

Weber asked the doctors how they could "feel" a drug is better. She said it boils down to where the doctors are getting their information.

"We asked the doctors how they received information about the drugs. And many of the doctors said they relied on the representatives from the pharmeseutical companies. And, I must say, when we were visiting them in their offices, often times, there were one, two, three drug representatives lined up at their counters, delivering samples and trying to talk to the doctor. When those drug sales reps come around, they provide studies, but often studies that present their product in the most favorable view. Their job is to get the doctor to prescribe which is often a brand name."

Weber says patients need to be more proactive, and feel free to question their doctors' decisions.

"Doctors for a long time, this has been sort of the third rail. You're not allowed to ask a doctor what they prescribe. You're not allowed to question that. And, as with all kinds of medical procedures, now hospitals -- as you see -- they have to tell you what their success rates are for certain procedures and such. And you should be able to ask your doctor questions about this. 'Am I getting the drug that has the least amount of side effects? Am I getting the drug that's most cost effective? Am I getting a drug because you got money to speak on behalf of that company?'"

Versions of this story are being co-published by ProPublica, with public radio station WNYC in New York and with Digital First Media web sites and newspapers. ProPublica is an independent, non-profit newsroom that produces investigative journalism in the public interest.

ProPublica has built a Prescriber Checkup widget – search the prescriber data directly:

Or search online for your doctor’s Medicare prescriptions at projects.propublica.org/checkup/

About the author

David Brancaccio is the host of Marketplace Morning Report. Follow David on Twitter @DavidBrancaccio
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Unfortunately, I only heard part of the story as I was busy at work trying to prescribe generic drugs to my patients. I have issue with several of the points your reporter made. 1) doctors don't know drug prices. I am very aware of how much medications cost my patients both based on cash or copay. I know what pharmacies have the cheapest drugs for cash paying patients (including the $4 list) and give discount cards when I can (but they are not available for Medicare D patients). 2) The drug companies leave pens and paper lying around promoting their products. This has not been allowed for several years. If I have any in the office they are leftovers! And meals? In our office, we have lunch with the reps twice a month. Pizza, pasta or sandwiches. And, I have always felt offended that people feel that I am so easily bribed that a few slices of pizza and a cookie will make me prescribe a drug. 3) Even if the copay for brand drugs is low such as discussed for the low income plans, in my experience, in order to get the insurance to pay for most brand medications we need to go thru a prior authorization process. Of course, the doctor can lie about the patient's experience with generics in order for the authorization to go through. Doctors need to educate the patients about the equivalency of most generics (there are exceptions) and not give in. It seems that the patients discussed in the story are getting their drugs thru a taxpayer funded, reduced cost plan. They shouldn't be allowed to chose more expensive drugs when the generic is not inferior. If they perceive that they need the brand, they can pay. I could go on and on but need to take care of some more patients.
A very busy and cost conscious primary care doctor

I appreciate hearing the side of the story from the consumer's and Medicare's point of view, but I would like a more balanced view from the physician perspective. It is untrue to say that we don't care about price. Many of our patients have co-insurance for their brand name prescription drugs, so they pay 20% of the cost of brand name drugs, while generics are $4-10 per month. It is also untrue to say that "there is usually a generic medication that will work as well". I practice in a working class community and have many patients with diabetes and COPD. Most of the medications used to treat those diseases are still brand name, such as the insulins and inhalers for COPD.

From the 6th paragraph:
“When those drug sales reps come around, they provide studies, but often studies that present their product in the most favorable view. Their job is to get the doctor to prescribe which is often a brand name.”

So, when ProPublica sponsors a study that is called “science”. When an evil capitalist money grubbing drug company that just want to get rich stealing money from the elderly sponsors a study, it is at best suspect, but really a 100% fraud.

I thought “studies” were science. I did not know left wing tax fraud companies like ProPublica decides what is science and what is not science.

Evil capitalist drug companies save lives. Evil capitalist drug companies take huge risks to save lives of drug users who need these drugs to survive. Left wing tax fraud companies like ProPublica never saved a life. The fraudulent “non-profit” ProPublica needs to come clean and pay taxes.

Generic drug makers have never taken the massive risk of developing a drug. Generic drug makers are only an army of lawyers that break drug patents. They outsource the stolen drug to be manufactured in India.

When ProPublica run all the drug companies out of the USA then only the government sponsors the development of drugs. Then politicians will decide what drugs are funded for development. So the next Bill Clinton will defund cancer drug research for drugs to make female interns more attracted to older men in authority.

Excellent show. Thank you for educating the public on this problem.

This problem is far more widespread than ProPublica and your show would make it appear. One doctor in my area has a habit of prescribing expensive brand names. Once I asked my pharmacist if there were less expensive generics to the drug I was prescribed. She indicated yes but that I would require my doctor to rewrite the prescription. I called my doctor's office back to request an updated generic prescription, but received the runaround when I indicated the nature of my call. After several call backs, the doctor finally agreed on prescribing the generic. Apparently he "mistakenly" believed that I also had a condition which required a more expensive brand name, and believed the generic would not be "as effective". He rewrote me a generic prescription and requested that I change my doctor. Needless to say the generic not only worked perfectly, but saved me a substantial amount of money and I changed doctors immediately after that.

A word of caution: You will now have a lot of paid employees working for brand name pharmaceutical companies and doctors who indulge in this practice, who will fill out comments here on your website criticizing ProPublica and this show for highlighting this problem. They will question the accuracy and objectivity of this show and the quality and efficacy of generics. Please do not get disheartened. They are only doing their job. After all that is what they will be paid to do.

Thank you for your wonderful show--I listen regularly.

I know from experience generics are not the same as brand name. I am on a blood pressure medicine where on the brand name I need to take 100mg. On the generic I only need to take 75mg. When I take the generic 100mg dose it causes me to run low on energy. Dr was surprised but the results but we tested it several times. His thinking was the dissolving rate of the drug.

This story is one-sided and a bit unfair. Davis put words in doctors' mouths when he complained about their prescribing brand drugs because, he said, they "feel" they're better.

While Tracy Weber's finding that 900 doctors are responsible for $1 billion in drugs is noteworthy, the analysis doesn't stop there. How many are oncologists or other physicians who prescribe biologics to treat patients? Specialty meds don't have "generic" versions here in the U.S.

Finally, the prescribe rate for generics in the private insurance world is 85%. How much higher does Tracy want it to be? 95%? What would satisfy ProPublica?

Doctors should not make decisions based on "gut feeling." They're supposed to be scientists. They should be informed about research in their field and practice medicine accordingly. By in large generics are just fine.

I don't think this story suggested that a brand name drug never be prescribed when a generic is available. Rather, the point was that some doctors don't even consider generics. RPJordan's experience is just what doctors should be doing -- try out the generic first. If for some reason it doesn't work or there are problem side effects then it's time to try the brand name or to switch to a different medication that treats the same problem.

I was a bit surprised at the one-sided nature of this morning's piece on generics vs brand name drugs. I second the motion that you provide "the other side of the story". I take very few prescription drugs, and most of those that I do take are generic, but I have ocular hypertension ("pre-glaucoma") and after several months of a using generic eye drop, my doctor suggested I try the brand name version of the same drug, which proved to be significantly more effective. I have come to expect balanced reporting from NPR, this time you missed the mark. (BTW, I pay for my insurance--I'm not on Medicare, not that that really matters in this discussion.)

Yes, please have propublica doa story on how generic drugs can be plus or minus 20% of the stated dosage. How they can go from village to village in India and cherry-pick the successful trials for the FDA, whereas name brand drugs must present all of their data to the FDA. Cover how many siezure patients have been damaged by trying generics because -20% simply wasn't enough medicine. Cover the real story.

David: Love your show. I understand you and Kai will both cover this topic today. To improve and balance the story could you address the following: 1) why shouldn't a patient prefer my doctor's "gut feeling" based on his training and experience with thousands of patients as to which drug is better for me, to that of a public institution focused only on cost, such as the government or a nonprofit; 2) please find some scientists who can talk to the real and subtle differences in the branded and generic formulations of drugs, and the important variations in the same drug that can occur in different processes, sources of raw materials and other myriad other details of the chemical manufacturing process; and 3) you also could include some information about recent findings of deplorable, unsanitary conditions found in certain manufacturing sites of cheaper generic drug manufacturers, and differences in the strength of the regulatory regimes in the countries where they are made. The closing comment from ProPublica on your show suggests that doctors are favoring the companies out of some improper or corrupt motive--bit of a cheap shot don't you think? Where's the other side of this story?

Thanks for your wonderful show--I'm a regular.

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