April 17th, 2012

What’s in a Name? Go for the Generic

A recent report published in the Archives of Internal Medicine highlights some “low-hanging fruit” for anyone trying to deliver more cost-effective healthcare. The authors (I am the first author and Harlan Krumholz, CardioExchange editor-in-chief, is the senior author) describe how branded formulations of fenofibrate — marketed by Abbott as Tricor and Trilipix — account for the vast majority of fenofibrate prescriptions, even though generic fenofibrate has been available for almost a decade.

Abbott was able to stay one step ahead of the generic competition by repeatedly changing the dose of its branded formulations: clinicians continued to prescribe branded versions of the drug and pharmacists were powerless to switch these prescriptions for generics due to the differences in dose. We have helped reward Abbott with an astonishingly high market share, even though the company never demonstrated the incremental benefit of its reformulations.

As physicians, we should ask how this happened. Why did we not switch patients over to generic fenofibrate? Were we unaware that generics were available? Did we take for granted that generic substitution would happen at the pharmacy? Did we fail to notice the repeated changes made to the doses of branded fenofibrate?

Unlike most cost-effectiveness calculations, this one should be easy. This is not a complicated decision in which we need to weigh relative efficacy against relative cost: clinicians have a choice between branded fenofibrate and generic versions of the exact same drug — but the generics are half the price.

We should also remember that there is an ongoing debate about the appropriate role of fibrate therapy in lipid management in light of the findings from the FIELD and ACCORD trials, which showed that fenofibrate did not significantly improve cardiovascular outcomes. Regardless of your views on the efficacy of fenofibrate, do your patients and the healthcare system a favor – write the generic.

4 Responses to “What’s in a Name? Go for the Generic”

  1. Joseph Wildman, MD says:

    The BETTER answer is OBVIOUS and is even alluded to in the above post: Given the lack of any demonstrable benefit from fenofibrate–by any name and in any dose–JUST DON’T PRESCRIBE IT!! What possible rationale exists for using it, except perhaps in cases of extraordinarly high triglycerides?

  2. And Calan sold more than Isoptin, the same drug. Sometimes it is the name, and then in this case likely the supposition that the generic equivalent was allowed– as you pointed out. I know I was unaware of the dosage changes, and the resulting inability to substitute. You have enlightened me for this drug as well as for other brands and their generics. The fact that the pharmacist can’t substitute in cases like this is important to know.

    In my case, I have seldom prescribed the generic. But, then again, I haven’t prescribed the brand either. The likely lack of benefit was the determinant here.

  3. Juergen Schiefermueller, MD says:

    The last sentence should obviously have read: “In view of the lack of efficacy of fenofibrate, do your patients and the healthcare system a favor – don’t prescribe it.”

  4. Nicholas,

    Congratulations on your emphasis of the obvious. This, my friend, will serve you well in the future.

    Thank goodness for that last paragraph, and for the observation of the astute learner from the UK.

    Nice one Juergen. You took the words right off my keyboard.