Medicare prescribes more brand name drugs than VA

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NEW YORK (Reuters Health) - Medicare Part D beneficiaries are two to three times more likely than those covered by the U.S. Department of Veterans Affairs to be prescribed brand name diabetes drugs rather than generics, a new study suggests.

Because it doesn't seem the brand name versions work any better, researchers said the extra $1.4 billion Medicare spent on those drugs in 2008 may not have led to improved patient health.

"It represents essentially spending that is probably not necessary for most people," said Dr. Walid Gellad, from the Veterans Affairs Pittsburgh Healthcare System, who led the new study.

"There's no evidence that the VA is suffering any adverse effects or the patients are suffering any adverse effects because they're using generics," he told Reuters Health.

Gellad and his colleagues studied four classes of drugs used by people with diabetes, including oral hypoglycemic drugs, such as metformin, and statins like simvastatin (marketed as Zocor).

The proportion of patients on one of those drugs who used a brand name version rather than a generic varied greatly across the country, within both Medicare and the VA.

However, people covered by Medicare Part D - Medicare's prescription drug plan - were consistently more likely to get a brand name pill.

For example, 51 percent of Medicare statin users nationally took a brand name version, compared to 18 percent of VA statin users. Likewise, 35 percent of Medicare beneficiaries on oral hypoglycemics and 13 percent of their VA counterparts were prescribed brand name drugs, the researchers reported Monday in the Annals of Internal Medicine.

All VA benefits are managed by the same pharmacy company, and Gellad said that doctors have to justify why they are prescribing a brand name drug before the prescription will be filled.

That means patients typically only get a branded version if there's no close generic equivalent, or if they've already tried multiple generics and had side effects or didn't get better.

With Medicare, on the other hand, there are thousands of different lists of available prescription drugs depending on your pharmacy, said Dr. Alex Federman, who has studied generic drug use at the Icahn School of Medicine at Mount Sinai in New York.

"There's no unity there, so less of an opportunity to take advantage of an economy of scale to keep prices a little bit under better control," said Federman, who was not involved in the new research.

"We will never really realize those kinds of savings when we have a system that involves so many different players, when it's not centralized the way it is in the VA."

He said he doesn't see a system like the VA's as a political possibility for Medicare, but that Medicare and private insurers can still work to encourage doctors to consider costs in their prescribing. That would lower payments for insurers and patients alike.

"What this tells us is there are ways to take care of these patients with many fewer brand name drugs, and the question is, how do you get there?" Gellad said.

He and Federman agreed that patients themselves can ask for generic drugs - and know they aren't making a dangerous health decision.

"Patients are very often afraid of using generic medications," Federman told Reuters Health.

"They think that the quality is poorer and there's a great deal of resistance oftentimes to using them. Patients should not have those concerns."

Like brand name drugs, generics have to meet standards set by the U.S. Food and Drug Administration, Federman said - and there's no evidence they're inferior to more expensive originals.

"People have to ask, when they're given a drug, if it's expensive and they have difficulty affording it, whether there's a generic equivalent that they can try," Gellad said.

"The key issue has always been just to ask if there's a cheaper version."

SOURCE: Annals of Internal Medicine, online June 10, 2013.

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