Underuse of generic medications.
Underuse of generic medications.
复制标题
仿制药使用不足。
DOI：
10.1097/01.mlr.0000254511.09498.12
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发表时间：
2007
期刊：
影响因子：
3
通讯作者：
Kravitz,RichardL
中科院分区：
文献类型：
--
作者：
Kravitz,RichardL
In health care policy circles, high costs grab headlines, but rapidly escalating costs focus the mind. Spending on prescription drugs currently accounts for 11% of US health care expenditures. 1 More importantly, for most of the current decade, costs have been increasing fast. The causes are myriad and involve factors related to both supply (eg, high fixed costs associated with pharmaceutical research and development) and demand (eg, an aging population hankering to be “better than well”). 2 In developing solutions to complex policy problems, it often makes sense to start with the low-hanging fruit. Substituting generic drugs for their branded counterparts is generally safe, simple, and cost-saving; Haas et al 3 have estimated that switching older patients taking multisource drugs (those available both as brand and generic) from branded agents to their generic equivalents could save patients and their private or government insurers some $6 billion annually. Furthermore, for the uninsured and for those enrolled in tiered prescription drug insurance plans (including options offered under Medicare Part D), the use of generics may sharply limit out-of-pocket expenses and significantly improve adherence to treatment. 4In this issue of Medical Care, Federman et al 5 use Medicare data to show that, in 2001, the use of generic medicines for cardiovascular disease among US elders was suboptimal. Considering older adults with hypertension, coronary artery disease, or congestive heart failure who were taking at least 1 multisource drug in any of 5 therapeutic categories, the proportion of patients taking a generic agent ranged from 48%(alpha blockers) to 92%(thiazide diuretics). Among users of angiotensin-converting enzyme inhibitors, 59% took generics during a period when at least 2 long-acting generics (enalapril and lisinopril) were available (http://www. fda. gov/cder/approval). The corresponding figure for calcium channel blockers was 56%. These prevalence statistics are disappointing but not surprising. Most, but not all, analyses of Medicare and private insurance claims tend to reinforce the conclusion that generic medicines are substantially underused. 3, 4, 6 The potential for generic switching may be underestimated because most studies (present company included) fail to consider patients taking single-source branded drugs that could readily be switched to generic alternatives within the same class.
