Do doctors prescribe brand name over generic to make more money?

[Troyzle]

Now There’s Proof: Docs Who Get Company Cash Tend to Prescribe More Brand-Name Meds — ProPublica

I was watching an interview with Democratic presidential candidate Andrew Yang, and he was talking about how the drug company Purdue should take the blame for the opioid crisis. My first thought was that oxycontin is an extremely effective drug, and I don't think you can blame a company for distributing its product which has an extremely important role in medicine, but you should probably blame those over-prescribing it. So I looked into whether or not drug companies actually sway prescriptions and found the above article.

Tl;dr doctors prescribe brand name over generic 20% of the time when not receiving money from a drug company, and 30% of the time when they receive a payment/gift of >5k from a company.

My question is if you guys see this as a problem or if the article is missing important factors that go into this issue?

Second question is, does part of the blame for the opioid crisis go to drug companies?

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[GoSpursGo]

Moving to TIH.

The short answers are: 1) Correlation=/= causation. It probably depends on which drugs were being prescribed and how their study defines "brand name" vs "generic." Also, there may be nothing nefarious about the prescribing practices for something simple like a meal--it's not like the company invites the docs to dinner for fun, it's always framed as "let me tell you why our drug is better than our competitors' over dinner," and docs may (rightly or wrongly) come away with the impression that a particular brand is actually better. I think it's a little harder to explain away large sums of money or extravagant gifts being given by the companies.

2) Yes of course. I think we're seeing this play out in the courts now.

 

[smq123]

I was watching an interview with Democratic presidential candidate Andrew Yang, and he was talking about how the drug company Purdue should take the blame for the opioid crisis. My first thought was that oxycontin is an extremely effective drug, and I don't think you can blame a company for distributing its product which has an extremely important role in medicine, but you should probably blame those over-prescribing it. So I looked into whether or not drug companies actually sway prescriptions and found the above article.

The issue with Oxycontin and Purdue is NOT that Purdue over-incentivized doctors to prescribe Oxycontin.

The issue is that Purdue lied, or at least was not adequately forthright, about Oxycontin's addictive potential. If they had been honest about Oxycontin's very high potential for addiction, it's likely that more physicians would have been unwilling to prescribe the drug so freely.

https://psmag.com/social-justice/purdue-pharma-misled-people-about-the-strength-of-oxycontin

 

[Troyzle]

I see. I had no idea this was in the courts. I had heard of med schools renaming the facilities named after Sackler, but I didn't know why. Thanks for the response, guys!1

 

[Instatewaiter]

Now There’s Proof: Docs Who Get Company Cash Tend to Prescribe More Brand-Name Meds — ProPublica

I was watching an interview with Democratic presidential candidate Andrew Yang, and he was talking about how the drug company Purdue should take the blame for the opioid crisis. My first thought was that oxycontin is an extremely effective drug, and I don't think you can blame a company for distributing its product which has an extremely important role in medicine, but you should probably blame those over-prescribing it. So I looked into whether or not drug companies actually sway prescriptions and found the above article.

Tl;dr doctors prescribe brand name over generic 20% of the time when not receiving money from a drug company, and 30% of the time when they receive a payment/gift of >5k from a company.

My question is if you guys see this as a problem or if the article is missing important factors that go into this issue?

Second question is, does part of the blame for the opioid crisis go to drug companies?

I am going to get up on a soap box for a minute. Did you, or anyone who has responded, read the methods. For any paper, the methods will determine whether the publication may have merit or not. You can reach almost any finding if you change the methods to support what you are looking for. Most publications which tend to have a political message or are trying to drive policy in one direction or the other, have a bias in the methods.

The methods of this publication are just ok. The major issue here is whether the prescribed brand name drug had a generic equivalent (and of course they didn't determine if there was a generic equivalent). If there was no equivalent and the drug is needed, acutally the doctors who get pharma money are providing better care than those who don't.

Let's take a real world example in my specialty of cardiology. There was a recentish (~4 years ago) trial which compared ACE inhibitors to Neprilysin inhibitors + ARB (Entresto). There is a big survival benefit, lower hospitalizations, better symptoms overall. This gets it a class I (highest) recommendatiosn in the guidelines to change people from a likely genertic med to Entresto (has no generic). Not all cardiologists know about it. However those who have been given education by the maker of Entresto probably do. So, perhaps those patients of docs with pharma money will have a lower mortality rate and better care. We'll never know from this publication because they never looked...

Not everything is clear cut or nefarious. Actually, it may be the opposite. That is why the methods are so important.

 

[BeautifulSmiles523]

My boyfriend was being charged 380 per 10cc vial for testosterone by his doctor. The doctor first told him that he couldn't send the script to walgreens because they didn't cover it. When he found it on GoodRX, he asked if the doctor could just have a script sent to walgreens. The doctor said that he charged 200.00 for a script. He ended up finding a primary that would write him a script and used GoodRX to pay 35.00 per vial.

Some doctors are so greedy and corrupt.

 

[FutureInternist]

I carry a Wal-Mart $4 list during rounds so I can DC pts on the cheapest meds.