Generic push: More paperwork, more justification

With pharmaceutical costs on the rise, physicians are under more pressure to explain why they're recommending specific drugs and to fit those prescriptions into a health plan formulary.

By Mike Norbut, AMNews staff. March 6, 2006.

Popular brand-name drugs such as Zocor and Zoloft are losing their patents this year. Patients are enrolling in high-deductible health plans and health savings accounts, making them acutely aware of the price of prescriptions. And health plans are encouraging patients to ask their physicians for generic medication and even structuring formularies to steer them that way.

What does this mean for physicians? A whole new layer of practice management issues, more time to spend on administrative work and more pressure to consider cost in treatment.

Whether it involves enumerating the advantages of taking a brand-name drug over a generic or counseling patients on ways to trim their prescription drug costs, doctors can expect to spend more time on a subject for which historically they have not been questioned.

They also will have to deal with pharmaceutical sales representatives hoping to preserve some market share for their products or pitching a reformulated version of the old drug. Doctors even will have to be well-versed in various health plan formularies, since what they can prescribe often will be dictated by what the insurer allows.

In short, conversations no longer will be just about what works, but what's more affordable and what provides the best value, experts said.

"Doctors will have to know more about cost," said Devon M. Herrick, PhD, a senior fellow with the National Center for Policy Analysis in Dallas. "More often than not, they don't know the cost. Often, when you go to the doctor, he goes to the supply cabinet and pulls out samples."