Identifying Messages to PROmote Value & Education (IMPROVE) of Generic Prescribing

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PROJECT SUMMARY/ABSTRACT One of the most obvious, but unfortunately underused, strategies to improve value of care is prescribing generic drugs. A recent IMS Health report concluded that generic drug use “saved the American health care system more than $824 billion over the past decade, and $139.6 billion in 2009 alone.” Not only are generic drugs often 75% cheaper than retail prices of the brand-name, they are also equally efficacious. Some studies have even shown improved medication adherence, translating into better patient outcomes, with generics. Given the potential benefit to patients, payers, and the healthcare system, it is imperative that frontline clinicians take personal responsibility for prescribing generic medications for patients. While there is an overall high utilization of generic drugs in the U.S. compared to other countries, it is important to recognize that utilization of generics varies by therapeutic class. Namely, clinicians can be reluctant to prescribe generic antidepressants or oral contraceptives, two of the most routinely prescribed medications by primary care providers. Concerns regarding generic substitution in these classes center around dosing adjustments needed to achieve bioequivalence or nonadherence giving rise to unintended consequences such as depressive episodes or unintended pregnancy. In contrast, while there is a higher rate of prescribing generic cholesterol lowering drugs, the fill rate is lower and billions of dollars in excess are still spent each year on brand-name statins. Understanding prescriber barriers and facilitators to prescribing generic drugs is critical to improving ‘generic efficiency’ for a particular class of drugs, or the percentage of drugs in a class prescribed that are generic. Unfortunately, many clinicians may hold negative perceptions about generic medications. More than one-quarter of physicians in one survey would NOT use generics as first-line medications for themselves or for their family. Currently, pharmaceutical representatives are the most common information source about market availability of generic medications. This underscores the need for developing and testing powerful evidence- based messages that can counteract existing marketing strategies that promote prescribing costlier brand- name drugs. While educational interventions to improve generic prescribing have been attempted none are based on principles of adult learning theory or use stakeholder input to inform the messaging and learning strategy to achieve practice change. Our goal is to develop messaging and interventions to promote generic prescribing of antidepressants, oral contraceptives, and cholesterol lowering agents for busy time-crunched primary care clinicians, specifically nurse practitioners (NPs) and primary care physicians (PCPs).