Doctors, don't "dispense as written"

I've always favored prescribing generic drugs over handing out brand-name samples, since the latter, while initially "free" for patients, can actually be less effective and cost them more money in the long run. In fact, the only patient for whom I can remember routinely writing "Dispense as Written" (forcing the pharmacy to dispense the brand-name drug rather than the generic) on prescriptions was a special case: she insisted that I do so, because she believed that the brand-name worked better for her condition than the generic did. (And she may very well have been right, although she would have been a rare exception to the rule that generics are therapeutically equivalent to the brand-name drugs they replace.)

In an excellent story published in yesterday's Washington Post, however, health columnist and fellow Georgetown faculty physician Ranit Mishori reports that up to half of U.S. doctors prescribe brand-name drugs because they erroneously believe that generics are less effective, costing the U.S. health care system up to $8 billion per year. And that's only the cost savings associated with the differential in drug prices, which, in the case of the cholesterol drug Zocor (generic name: simvastatin), can be nearly $400 per month. Mishori goes on to write:

But the cost benefits may run deeper, because several studies also show that patients taking generics are more likely to take them properly. According to [Harvard Medical School professor William] Shrank, patients paying more for pharmaceuticals are “less likely to take their medication” as prescribed. Financially burdened by the cost of their drugs, they are more likely to skip doses so that their drug lasts longer, to cut the pill in half or, when they see the price rung up at the checkout counter, to leave the pharmacy with no medication at all. “And that,” he says, “is bad for clinical outcomes.” And expensive, too, when you consider the added burden to the system of people unwell because they are priced out of the medications they require.