Not Specifically

I am a big believer in FDA-approved generic drugs. They are safe and effective and represent an enormous opportunity for health care savings -- and I applaud insurance company programs that seek to educate consumers about them. But I am a big opponent of forced switching. Disempowering physicians and patients results in bad outcomes.

I am a big believer in getting the right medicine to the right patient in the right dose at the right time. But I am a big opponent of the Me-Tooistas, who think that all drugs within the same therapeutic category are, more-or-less, the same.

I believe in honesty and ethical behavior, and I have strong feelings when it comes to the topic of insurance companies not being transparent about providing financial incentives to physicians in order to influence their prescribing habits -- while misleading patients along the way.

Sometimes the best of intentions have serious unintended consequences.

Consider the Blue Care Network of Michigan (BCN). A program (now discontinued) sent letters out to their participating primary care physicians offering a $100 payment “for each member in their panel with a BCN pharmacy benefit who fills a prescription for a generic lipid lowering agent.”

Translation: We will pay you $100 for switching your patients to a generic statin.

According to a recent ABC investigative report, “Blue Care Network in Michigan paid 2,400 doctors $2 million to switch their patients from Lipitor to a generic version of its competitor, Zocor. They were paid $100 for each patient they switched from Jan. 1 through March 31, 2007.”

Translation Update: We will pay you $100 to switch your patient to a generic statin that isn't even a generic version of what they are currently taking.

When asked by the ABC reporter if patients knew their doctors were receiving payments from the insurance company in return for a service that helps to increase the profits of the insurance company, the response from BCN was “not specifically.”

Translation: No.

What ever happened to informed consent?

Here’s what BCN wrote to their customers being prescribed Lipitor:

“Our prescription claim records indicate you may be taking Lipitor® for high cholesterol. Another lipid lowering drug, Simvastatin, works as well as Lipitor® but is available as a generic and costs a lot less.”

Please note – the preceding paragraph is a verbatim quote from the BCN letter.

A few comments:

* As to “ … as well as …”, imagine if a pharmaceutical company tried to pull that one? They’d be hit by a DDMAC truck as fast as you can say, well, DDMAC.

Talk about an unlevel playing field.

* Seems to me (maybe it’s just me) that somebody's trying to make it sound like Simvastatin is a generic version of Lipitor. “… works as well as Lipitor® but is available as a generic …” You be the judge.

“Not specifically” seems to be more than an evasive answer to a journalist's question – it appears to also be a creative viewpoint on bioequivalence -- a flawed and dangerous one. Honestly folks, how will the average consumer read and understand such verbiage? It’s also interesting to note that nowhere in the consumer letter does it mention that doctors will be spiffed for making the switch.

Imagine if a pharmaceutical company engaged in such behavior? Can you say OIG investigation? Big fine? Congressional investigation?

Lastly (and by no means least), where are the medical guidelines on the best ways to monitor a patient (particularly an already stabilized one) being switched from one statin to another (specifically, from one molecule to another)?

Maybe the $100 payment paid for some CME on that count.

Or maybe, well, “not specifically.”

Transparency please.