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Generic drugs may remain lower-cost alternatives to brand-name medicines, but the Medicare Part D program could have saved roughly $1.7 billion in 2017 if doctors and patients had actively opted for these copycat treatments, a new study finds.

More specifically, the program would have saved $977 million that year if generics had been substituted for all of the brand-name medicines requested by prescribers. And if Medicare patients had sought generics instead of brand-name drugs, Medicare Part D would have saved another $673 million, according to the study published in JAMA Network Open.


Meanwhile, Medicare beneficiaries would have saved approximately $270 million if they and their health care providers had requested generics rather than brand-name medications. All totaled, prescriber and patient requests accounted for 30% of all brand-name drugs dispensed, despite laws in all 50 states encouraging generic drug dispensing.

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  • The buried lede is in the third-from-last graf. I suspect that if the NTI drugs (primarily anticonvulsants) were washed out of the data, the brand-vs-generic differential would look substantially less alarming.

    • Interesting point. However, our results suggest that physicians and patients request a wide range of drugs beyond NTI (narrow therapeutic index) drugs. We found that all the drugs in our sample had at least one claim dispensed with a branded product because of a physician request (DAW1) and because of a patient request (DAW2); and the lists of most commonly requested branded drugs per physician and patient request included a range of therapeutic classes beyond NTI, such as antihypertensives, sedative/hypnotics and others. NTI drugs are part of the issue and should be addressed accordingly, but they are not the whole story.

  • Instead of saying how many brand name Rx are filled, may one observe the counterpoint? “Among 169 million claims for the 224 multi-source drugs, a brand-name drug was dispensed 5% of the time…” This says to me that 95% f these were filled with generics. May one observe that seems to be very strong brand enetration?

  • Good point Ed, BUT , lets assume the Dr does request a generic drug, the pharmacist processes the claim and
    it rejects! NDC not covered, bill for brand ! If you think this doesn’t happen your wrong ! This happens so many times a week. The funny thing about this is that in many cases the generic is made by the brand name company!
    Example, Symbicort, Advair, Humalog just to name a few. Why does this happen? Because there is no drug rebate for the generic version yet is could be $100 cheaper and it’s made in the same factory ! So tell me, who is practicing medicine in this country? It’s not the Doctors, they have no say , It’s the PBM’s that minipulate our
    system for their own greed and profits! Medicare and medicaid could have saved billions of dollars. Instead this money went into to PBM’s greedy pockets !!!! It’s sickening !!!!!!!

    • Well said, Ed. You are exactly correct. Not only do PBMs collect rebates from the pharmaceutical companies, you the patient pay the inflated list price for the drug at the pharmacy counter and the PBM gets that too. Nice work if you can get it!

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