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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