Identifying Messages to Promote Value and Education of Generic Prescribing

Cost Savings and generic substitution of oral contraceptives (OCPs)

 

OCPs Commonly Used

• •25% of reproductive age women report using OCPs 

• •Low failure rates1 

• •Almost all available as generic2 

http://www.flowersfertility.com/flowersfertility/2014/6/4/what-fertility-awareness-based-methods-fabms-are-not-the-least-popular-form-of-birth-control

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Concerns About Generic OCPs Overblown

• •ACOG committee opinion supported requests for brand OCPs due to concerns about packaging and adherence3 

• •Multiple studies show increased adherence with generic drugs 

• • •OR 1.62 of adherence in analysis of claims data primarily looking at OCPs4 

• •Health policy implications of lower cost of generic OCPs  

 

Barriers to Prescribing Generics Exist

• •Focus group data from ACP & AANP meetings identified barriers to prescribing generic OCPs: 

• • •attitude & knowledge regarding generics, lack of trusted sources, multiple generic brands for OCPs 

 

Generic Skepticism Decreasing But Still Exists

• •Generic skepticism: lack of agreement that generics are as effective as, as safe as, or do not cause more adverse events than their brand counterparts.  

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% Skeptic

 

Generic skepticism of safety & efficacy of generic drugs is declining but still exists among clinicians across multiple disciplines.

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Remember: Generics are Therapeutically Equivalent!

• •The FDA considers generic and brand OCPs Therapeutically Equivalent 

• •This means they are both  

• 1. 1.Phamaceutical Equivalent: Same active ingredients, dosage form, route of administration, strength/concentration 

  2. 2.Bioequivalent: No significant difference in rate or degree to which the active ingredient in a pharmaceutically equivalent drug product becomes available at the site of action, when administered at same molar dose 

 

FDA Approval Process Rigorous

• •All generics go through rigorous testing before approval 

• •Manufacturers of generics must prove their drug is “therapeutically equivalent” to brand name 

• •Adverse events closely monitored for generic drugs 

• •www.FDA.gov/GenericDrugs 

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Cost Savings from OCPs Substantial

• •Usage and cost of OCPs derived from the 2010-2014 Medical Expenditure Panel Survey (MEPS)5 

• •Estimated total brand name OCP expenditure: $916 million 

• • •$171 million out-of-pocket 

• •Estimated total avoidable cost opportunity: $456 million 

  • •$37 million out-of-pocket 

 

Cost Savings Translated to Patients

• •The estimated total out-of-pocket savings 

• • •$751 million between 2010-2015  

OCP Type	Average OOP Cost Per Year	Average Total Cost Per Year
Brand	$117.15	$427.06
Generic	$59.53	$163.24
Potential Savings of Switching	$57.62	$263.82

 

Having a Discussion With Your Patient Matters

• •Patients who reported having a discussion with their clinicians were 5x more likely to switch to a drug of lower cost9 

Reduce OOP costs by half

Societal savings

In other commonly prescribed drug classes, like statins, where adherence is suboptimal, generic drugs are associated with better adherence and better health outcomes. 10,11

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References

1. 1.Trussell J. Contraceptive failure in the United States. Contraception. 2011;83(5):397-404. doi:10.1016/j.contraception.2011.01.021. 

2. 2.Hall KS, Trussell J. Types of combined oral contraceptives used by US women. Contraception. 2012;86(6):659-665.  

3. 3.American College of Obstetricians and Gynecologists Committee on Gynecologic Practice,. ACOG Committee Opinion No. 375.; 2007:447-448. 

4. 4.Shrank WH, Hoang T, Ettner SL, et al. The implications of choice: Prescribing generic or preferred pharmaceuticals improves medication adherence for chronic conditions. Arch Intern Med. 2006;166(3):332-337.  

5. 5.Agency for Healthcare Research and Quality. Medical Expenditure Panel Survey (MEPS). Rockville, MD https://meps.ahrq.gov/mepsweb/index.jsp. 

6. 6.Bioequivalence between brand-name and generic OCs. Contracept Rep 2002; 13(2):6-9. 

7. 7.G. Evans, E.L. Sutton. Oral contraception. Med Clin North Am, 99 (2015), pp. 479-503 

8. 8.Kesselheim, A. S., Gagne, J. J., Eddings, W., Franklin, J. M., Ross, K. M., Fulchino, L. A., & Campbell, E. G. (2016). Prevalence and predictors of generic drug skepticism among physicians: results of a national survey. JAMA internal medicine, 176(6), 845-847. 

9. 9.Wilson, I. B., Schoen, C., Neuman, P., Strollo, M. K., Rogers, W. H., Chang, H., & Safran, D. G. (2007). Physician–Patient Communication About Prescription Medication Nonadherence: A 50-state Study of America’s Seniors. Journal of General Internal Medicine, 22(1), 6–12. http://doi.org/10.1007/s11606-006-0093-0 

10. 10.Joshua J. Gagne, Niteesh K. Choudhry, Aaron S. Kesselheim, Jennifer M. Polinski, David Hutchins, Olga S. Matlin, et al. Comparative Effectiveness of Generic and Brand-Name Statins on Patient Outcomes: A Cohort Study. Ann Intern Med. 2014;161:400–407. doi: 10.7326/M13-2942 

11. 11.William H. Shrank, Tuyen Hoang, Susan L. Ettner, Peter A. Glassman, Kavita Nair, Dee DeLapp, June Dirstine, Jerry Avorn, Steven M. Asch. The Implications of ChoicePrescribing Generic or Preferred Pharmaceuticals Improves Medication Adherence for Chronic Conditions. Arch Intern Med. 2006;166(3):332–337. doi:10.1001/archinte.166.3.332 

 

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