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Doctors may be encouraged to prescribe lower-cost generics, but a new study found that Americans spent an extra $73 billion between 2010 and 2012 on pricier brand-name drugs because physicians failed to sufficiently recommend these copycat treatments to their patients. And consumers paid nearly one-third of those additional costs through out-of-pocket payments. Notably, the study found that the excess spending occurred when a generic version was not available for a specific brand-name drug, but a doctor could have prescribed a lower-cost, copycat for a similar brand-name medicine. For example, instead of prescribing a lower-cost generic for a brand-name cholesterol pill, a doctor might have prescribed a similar brand-name cholesterol medicine. (Silverman, 5/9)

"We wanted to see how much patients and society as a whole could save through the use of therapeutic substitution, in terms of both overall and out-of-pocket expenses on brand drugs, when a generic drug in the same class with the same indication was available," said lead investigator Dr. Michael Johansen. He is a family medicine physician with the Ohio State University Wexner Medical Center, in Columbus. (Dallas, 5/10)

The new JAMA Internal Medicine study is among the latest to focus on reducing costs by curbing the over-prescription of brand-name drugs. Many clinicians have been reluctant to engage in the practice, especially when it comes to prescribing therapeutic substitutes, over fears the drugs could result in worse clinical outcomes for patients. The study also points to another clear incentive to prescribe pricier drugs. “Pharmaceutical companies frequently provide rebates to payers,” noted authors Dr. Michael Johansen of Ohio State University and Dr. Caroline Richardson of the University of Michigan. (Rice, 5/9)

The most excess money was spent on statins to lower cholesterol, with an excess expenditure of $10.9 billion; and atypical antipsychotics for mental disorders, with a $9.9 billion excess. Proton pump inhibitors to reduce stomach acid incurred an extra expense of $6.12 billion; and selective serotonin reuptake inhibitors, for depression, $6.08 billion. ... Certain classes of drugs were omitted from the analysis, including some antibiotics and respiratory drugs and testosterone. Insulin was also omitted, because no generic form is available. (Fikes, 5/9)

Therapeutic substitution, or swapping one drug for a generic or chemically different agent within the same class, could save the US healthcare system billions of dollars annually. And although a new survey shows physicians are warming up to generic drugs, some critics warn that the indiscriminate use of therapeutic substitution could come at the expense of patient health and safety. (Osterweil, 5/9)

Patients prescribed and dispensed a brand-name drug instead of an equivalent generic version spent an estimated total of $24.6 billion in excess prescription drug costs between 2010 and 2012, a new study has uncovered. The study published in JAMA Internal Medicine sought to calculate the potential impact of therapeutic substitution—defined as when a brand-name drug is substituted for a generic within the same class but with different chemical compounds—on potential savings for both patients and the US health system. (Gilchrist, 5/9)