Study: Generic Prescribing Increased When Sales Rep Influence Was Limited

CVS Health and the Association for Accessible Medicines (AAM) praised a recent study that found that policies limiting pharmaceutical sales activities at academic medical centers resulted in an increase in the prescribing of generic drugs.

The study, published in JAMA, explained how these medical centers had enacted policies to restrict pharmaceutical representative sales visits to physicians (a practice known as detailing) in order to avoid conflicts of interest.

Researchers at UCLA Medical Center in Los Angeles and Carnegie Mellon University in Pittsburgh compared changes in prescribing behavior of 2,126 physicians at 19 academic medical centers before and after enactment of policies against detailing to changes in prescribing behavior of 24,593 matched control physicians during the same periods.

Pharmacy claims data was provided by CVS Health for eight drug classes used to treat common chronic conditions for which lower-cost generics are available. The conditions include hypertension and hypercholesterolemia.

After policies against detailing were implemented, there was a 1.67% decrease in the market share of detailed drugs and a 0.84% increase in the market share of non-detailed drugs, more than 95% of which are generics.

“Implementation of policies at [academic medical centers] that restricted pharmaceutical detailing between 2006 and 2012 was associated with modest but significant reductions in prescribing of detailed drugs across six of eight major drug classes,” the researchers wrote. “However, changes were not seen in all of the [academic medical centers] that enacted policies.”

The new research underscores the need for continued monitoring of pharmaceutical marketing practices and “the ongoing adoption of programs and policies that increase the availability and utilization of generic drugs in the marketplace, as a way to help drive down overall drug spending,” CVS Health said in a statement.

"Physician visits from drug sales representatives help keep expensive brand name drugs top-of-mind for physicians, which can ultimately impact their prescribing behavior," said Troyen A. Brennan, MD, a co-author of the study and Chief Medical Officer of CVS Health. "At a time when the cost of prescription drugs and pharmacy care is under increased scrutiny, this new data shows that policies to restrict pharmaceutical sales calls can lead to increased prescribing of equally effective, less expensive generic drugs.”

Allen Goldberg, Vice President of Communications for AAM, which promotes generic and biosimilar drugs, thanked CVS for “shining a light on the importance of generics and their role in driving savings for patients,” he told Drug Topics. “According to FDA, generics are 80% to 85% less expensive than brand equivalents. While generics are nine out of ten prescriptions, these drugs account for only 26% of spending by government programs and commercial markets on medicines,” Goldberg said.

While generic drug manufacturers have sales teams, they don’t call on doctors like brand companies, according to Goldberg. “Rather, generic sales representatives are working with wholesalers, pharmacies, etc.”

A separate editorial in JAMA, published in the same issue, cited research showing that the overuse of expensive brand name medications resulted in around $73 billion in additional costs to the U.S. health-care system between 2010 and 2012. About a third of these costs were paid for by patients, according to the editorial.