Substituting in-class generics for branded drugs could save billions

Between 2010 and 2012, $73 billion could have been saved by substituting a generic or over-the-counter medication for a brand name drug in the same class, according to new research.

The study, published May 9 in JAMA Internal Medicine, found such therapeutic substitution represented nearly 10 percent of all spending, with $25 billion in out-of-pocket spending by patients.

“Although therapeutic substitution is controversial, it offers a potential mechanism to significantly decrease drug costs if it can be implemented in a way that does not negatively affect quality of care,” wrote study authors Michael Johansen, MD, MS, and Caroline Richardson, MD.

Among classes where branded drugs were most commonly used in place of a similar generic were statins, atypical antipsychotics and selective serotonin reuptake inhibitors (SSRIs).

An accompanying editorial by Joseph S. Ross, MD, MHS, noted it is common practice for physicians to write prescriptions using brand names, in some cases because it’s easier to remember. State laws and Medicaid insurance generally allow for generic substitution if an FDA-approved generic exists.

But complications arise when no generic exists, but there is one for another drug in the same class. Different SSRI medications, for example, may have similar efficacies but differing adverse effects.

“To achieve the benefits of within-class substitution, we need wider adoption of systematic protocols, aligned with physician judgment, as to when such substitutions are beneficial and when not,” Ross wrote. “This work is not easy; it requires close collaboration between physicians and pharmacists, but the financial savings will be large.”