Nav: Home

Therapeutic substitution could help reduce money spent on prescription drugs

May 09, 2016

An extra $73 billion was spent between 2010 and 2012 on brand name medications and the practice of therapeutic substitution (substituting chemically different compounds within the same class of drugs for one another) could help to drive down those costs, according to a new study published online by JAMA Internal Medicine.

Therapeutic substitution is a controversial way to improve the efficiency of the pharmaceutical market because it is opposed by many physician organizations as an attack on physician autonomy.

Michael E. Johansen, M.D., M.S., of Ohio State University, Columbus, and Caroline Richardson, M.D., of the University of Michigan, Ann Arbor, used data on 107,132 individuals in the Medical Expenditure Panel Survey, along with their reported prescription medicine use, to estimate potential savings through therapeutic substitution. The authors looked at overall and out-of-pocket expenditures.

The study included drug classes that in a given year contained both a generic or widely accessible over-the-counter (OTC) drug and a brand name drug without an available chemically equivalent generic.

Of the 107,132 individuals, 62.1 percent reported using prescribed medicine between 2010 and 2012 and 31.5 percent used medication from an included drug. A branded drug from an included class was used by 16.6 percent of individuals compared with 24 percent who used a generic and 9.1 percent who used both, according to the results.

Overall, $760 billion was spent on prescription medications between 2010 and 2012. The extra money spent because of brand drug overuse accounted for 9.6 percent of total prescription medication expenditures. Total out-of-pocket expenditures between 2010 and 2012 were $175 billion, of which 14.1 percent were because of brand drug overuse, according to the results.

Drug classes where the most extra money was spent included statins, atypical antipsychotics, proton pump inhibitors, selective serotonin reuptake inhibitors and angiotensin receptor blockers, the study notes.

The authors note a number of study limitations, including estimates of pharmaceutical rebates and the overuse of branded drugs within drug classes.

"There was a large amount of excess expenditure on branded drugs between 2010 and 2012 in classes that could have incorporated therapeutic substitution. Although therapeutic substitution is controversial, it offers a potential mechanism to decrease drug costs if it can be implemented in a way that does not negatively affect quality of care," the authors conclude.
-end-
(JAMA Intern Med. Published online May 9, 2016. doi:10.1001/jamainternmed.2016.1704. Available pre-embargo to the media at http://media.jamanetwork.com.)

Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

Media Advisory: To contact corresponding study author Michael E. Johansen, M.D., M.S., call Sherri Kirk at 614-293-3737 or email Sherri.Kirk@osumc.edu.

Video and audio content: A video and audio report is available for preview under embargo at this link. It will be available for download at this link on Friday at 2 p.m. ET with broadcast-quality video and audio files, B-roll, scripts, and other images. Please email JAMAReport@synapticdigital.com with any questions.

Other available related material:
  • Original Investigation: "Association of Industry Payments to Physicians with the Prescribing of Brand Name Statins in Massachusetts"
  • Editorial: "Promise and Peril for Generic Drugs"
  • Editor's Note: "Therapeutic Substitution - Should It Be Systematic or Automatic?"
  • Letters: "Prevalence and Predictors of Generic Drug Skepticism Among Physicians: Results of a National Survey"
  • Letters: "Generic Medication Prescription rates After Health System-Wide redesign of Default Options Within the Electronic Health Record"

To place an electronic embedded link in your story: Links will be live at the embargo time: http://archinte.jamanetwork.com/article.aspx?doi=10.1001/jamainternmed.2016.1704

The JAMA Network Journals

Related Drugs Articles:

Using drugs for different diseases than initially intended for
Thousands of drugs have the potential to be effective against other diseases than they were developed for.
Virtual development of real drugs
systemsDock is a new, free on-line resource that makes screening for drugs faster and more accurate.
Migraine drugs underused
New research shows that more migraines could be safely treated with drugs that are known to constrict blood vessels.
Why cancer drugs can't take the pressure
A major reason why cancer drugs fail is that they cannot penetrate the high-pressure environment of solid tumors.
Designing better drugs
A new strategy for engineering protein fusions -- to make specific cell-targeted drugs without side effects -- could enable a safer, more potent class of protein drugs.
More Drugs News and Drugs Current Events

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Anthropomorphic
Do animals grieve? Do they have language or consciousness? For a long time, scientists resisted the urge to look for human qualities in animals. This hour, TED speakers explore how that is changing. Guests include biological anthropologist Barbara King, dolphin researcher Denise Herzing, primatologist Frans de Waal, and ecologist Carl Safina.
Now Playing: Science for the People

#534 Bacteria are Coming for Your OJ
What makes breakfast, breakfast? Well, according to every movie and TV show we've ever seen, a big glass of orange juice is basically required. But our morning grapefruit might be in danger. Why? Citrus greening, a bacteria carried by a bug, has infected 90% of the citrus groves in Florida. It's coming for your OJ. We'll talk with University of Maryland plant virologist Anne Simon about ways to stop the citrus killer, and with science writer and journalist Maryn McKenna about why throwing antibiotics at the problem is probably not the solution. Related links: A Review of the Citrus Greening...