Provider Insider

Making the switch: the value of transitioning patients to generic medications

 

Introduction

 

Branded medications frequently are prescribed for a variety of reasons: provider preference, direct-to-consumer advertising, therapeutic niche, mistake, etc. Sometimes branded agents have unique mechanisms of action and could be beneficial for patients, especially if they have not responded to other therapies; however, many of these products commonly have a generic alternative that is therapeutically equivalent, but much less expensive.

 

The importance of generic medications for patients and the health care system.

 

Generic medications not only save the health system valuable health care dollars, they often are much less expensive for patients. The FDA estimates that generic medications cost an average of 85% less than brand medications.¹ Also, three times more patients have been shown to abandon or be non-adherent to their branded medications; this is likely due to high-cost copays. It is estimated that only 39% of branded medication copays are under $20. By comparison, 90% of generic medication copays are under $20. As such, switching patients from a brand name medication to a generic may improve adherence simply from a cost perspective.²

 

Within Coordinated Care, brand-to-generic interventions have the potential to directly impact our Quadruple Aim by:

• Reducing costs.
• Improving patient experience by decreasing copays and improving outcomes through improved adherence
• Improving care team well-being by decreasing patient complaints related to the cost of medications.
• Improving population health by addressing quality-based metrics of adherence and comprehensive medication review.

Interventions to identify patient candidates who may benefit from switching from brand to generic medications are underway within Coordinated Care.

 

Already, centralized clinical pharmacists are identifying patients currently taking specific high-cost medications (outlined in Appendix A) through custom, population health-generated reports. These patients are contacted and asked if they would like to switch to the generic equivalent of their medication. If so, a recommendation or new prescription is pended for their primary care provider’s review.

 

In addition, this clinical pharmacy team is performing prospective comprehensive medication reviews (CMRs) for patients with upcoming appointments with the intent of optimizing chronic condition management and ensuring accurate medication lists. Part of this process is identifying high-cost medications, assessing barriers to access of these medications (if any), and recommending less expensive, therapeutic alternatives (as applicable).

 

The following tables illustrate the potential cost savings from switching from a brand to a generic product in patients with COPD/asthma, and guidance on how to do so (switching from brand name ICS/LABA combination products to generic Wixela).

 

 

 

 

Key messages:

• Switching/starting generic alternatives can have a large financial benefit for patients and the health system (Tables 1 and 2), as well as potential improved adherence to therapy.
• Coordinated Care centralized clinical pharmacy team is actively identifying patients eligible for brand to generic medication switching. Potential medication opportunities are outlined in Appendix A.
• One current initiative is to more frequently utilize generic fluticasone/salmeterol (Wixela) for patients with COPD/asthma. Providers can do so by choosing generic products when initiating ICS/LABA therapy or considering switching patients from current ICS/LABA combination product to Wixela (Table 3).

 

Questions or comments? Please contact [email protected].

 

Kyle Troksa, PharmD, PGY2 Ambulatory Care Resident, authored this article.

 

 

References:

1. Food and Drug Administration. fda.gov/drugs/generic-drugs/generic-drug-facts
2. Association for Accessible Medicines.
   org/resources/blog/2017-generic-drug-access-and-savings-us-report
3. 2019 UptoDate.

 

Appendix A: High-Cost Medications (not all-inclusive)

Common high-cost medications that could potentially be addressed:

• Advair → change to Wixela (generic fluticasone/salmeterol).
• Fortamet → change to generic metformin.
• Nascobal → assess need for B12 supplementation and change to PO, IM or SQ cyanocobalamin.
• Bystolic → change to metoprolol or carvedilol.
• Myrbetriq → assess previous anticholinergic medications, consider switch to tolterodine or other generic anticholinergic.
• Januvia → assess current and previous antihyperglycemic medications, consider switch to cheaper and more effective medication or optimization of current regimen.
• Janumet → assess current and previous antihyperglycemic medications, consider switch to cheaper and more effective medication or optimization of current regimen.
• Cambia → change to generic diclofenac.
• Vyvanse → assess previous stimulant trials, consider switching to other generic stimulant.
• Toviaz → assess previous anticholinergic medications, consider switch to tolterodine or other generic anticholinergic.
• Dymista → change to generic fluticasone monotherapy.