Physicians often give in to patient demand for brand-name drugs

When patients specifically request a brand-name drug and a generic equivalent is available, 44 percent of cardiologists will write the prescription for the brand-name medication, according to a nationwide survey of physicians’ prescribing habits. That is 7 percentage points higher than physicians overall.

The results were published online as a research letter Jan. 7 in the Journal of the American Medical Association Internal Medicine.

Eric G. Campbell, PhD, of Harvard Medical School in Boston, and colleagues surveyed 2,938 physicians about their prescribing practices, and 1,891 completed the survey, a 64 percent response rate. The participants were asked about their likely response when a patient requests a brand-name drug and an equivalent generic alternative is available. They also were asked about their relationships to the pharmaceutical industry.

Overall, 37 percent of surveyed physicians prescribed brand-name drugs when an equivalent generic was available if asked by a patient to do so. Physicians who had been in practice for more than 30 years were far more likely to prescribe the brand name (43 percent) than physicians in practice between 11 and 30 years (36 percent) or those in practice 10 years or less (31 percent). Internal medicine specialists and psychiatrists were most likely to prescribe the brand name (50 percent), followed by cardiologists (44 percent). The specialists least likely to prescribe the brand-name drug were pediatricians (17 percent), general surgeons (20 percent) and anesthesiologists (26 percent).

Physicians in one or two physician practices were most likely to comply with a patient’s request for a brand name drug (46 percent); physicians who described their practice setting as “HMO or other” were least likely to prescribe the brand name (29 percent). 

The authors noted with concern that Industry relationships seemed to play a large role in the physician’s willingness to prescribe brand-name drugs: 42 percent of physicians who received gifts or reimbursement of travel expenses from a pharmaceutical company would prescribe brand-name drugs, as would 40 percent of those who received free drug samples and/or payments for speaking and consulting, and 39 percent who accepted food or beverages from pharmaceutical companies in the workplace. Similarly, those who largely relied on pharmaceutical industry representatives to keep them up to date were more likely to prescribe brand name drugs than those who did not (40 percent vs. 37 percent).

These results “suggest that the unnecessary costs associated with this practice to the health system could be substantial,” they wrote.

Based on their findings, the study authors advocated interventions such as establishing systems that give the pharmacy primary control over which drug to dispense, with physician override in appropriate cases,and policies that prevent individual physicians from receiving samples, food or other benefits in the workplace.

For more on cardiologists' accessibility to drug representatives, please read "Prescribing Benefit, Risk to Drug Sales Reps" in the November issue of Cardiovascular Business.