Not Specifically

  • by: |
  • 08/22/2007
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.

Center for Medicine in the Public Interest is a nonprofit, non-partisan organization promoting innovative solutions that advance medical progress, reduce health disparities, extend life and make health care more affordable, preventive and patient-centered. CMPI also provides the public, policymakers and the media a reliable source of independent scientific analysis on issues ranging from personalized medicine, food and drug safety, health care reform and comparative effectiveness.

Blog Roll

Alliance for Patient Access Alternative Health Practice
Better Health
Biotech Blog
CA Medicine man
Cafe Pharma
Campaign for Modern Medicines
Carlat Psychiatry Blog
Clinical Psychology and Psychiatry: A Closer Look
Conservative's Forum
Club For Growth
Diabetes Mine
Disruptive Women
Doctors For Patient Care
Dr. Gov
Drug Channels
DTC Perspectives
Envisioning 2.0
FDA Law Blog
Fierce Pharma
Fresh Air Fund
Furious Seasons
Gel Health News
Hands Off My Health
Health Business Blog
Health Care BS
Health Care for All
Healthy Skepticism
Hooked: Ethics, Medicine, and Pharma
Hugh Hewitt
In the Pipeline
In Vivo
Internet Drug News
Jaz'd Healthcare
Jaz'd Pharmaceutical Industry
Jim Edwards' NRx
Kaus Files
Laffer Health Care Report
Little Green Footballs
Med Buzz
Media Research Center
More than Medicine
National Review
Neuroethics & Law
Nurses For Reform
Nurses For Reform Blog
Opinion Journal
Orange Book
Peter Rost
Pharm Aid
Pharma Blog Review
Pharma Blogsphere
Pharma Marketing Blog
Pharmacology Corner
Pharmaceutical Business Review
Piper Report
Prescription for a Cure
Public Plan Facts
Real Clear Politics
Shark Report
Shearlings Got Plowed
Taking Back America
Terra Sigillata
The Cycle
The Catalyst
The Lonely Conservative
Town Hall
Washington Monthly
World of DTC Marketing
WSJ Health Blog