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Journal of General Internal Medicine

, Volume 22, Issue 5, pp 645–648 | Cite as

What’s in a Name? Use of Brand versus Generic Drug Names in United States Outpatient Practice

  • Michael A. Steinman
  • Mary-Margaret Chren
  • C. Seth Landefeld
Original Article

Background

The use of brand rather than generic names for medications can increase health care costs. However, little is known at a national level about how often physicians refer to drugs using their brand or generic names.

Objective

To evaluate how often physicians refer to drugs using brand or generic terminology.

Design and Participants

We used data from the 2003 National Ambulatory Medical Care Survey (NAMCS), a nationally representative survey of 25,288 community-based outpatient visits in the United States. After each visit, patient medications were recorded on a survey encounter form by the treating physician or transcribed from office notes.

Measurements

Our main outcome measure was the frequency with which medications were recorded on the encounter form using their brand or generic names.

Results

For 20 commonly used drugs, the median frequency of brand name use was 98% (interquartile range, 81–100%). Among 12 medications with no generic competition at the time of the survey, the median frequency of brand name use was 100% (range 92–100%). Among 8 medications with generic competition at the time of the survey (“multisource” drugs), the median frequency of brand name use was 79% (range 0–98%; P < .001 for difference between drugs with and without generic competition).

Conclusions

Physicians refer to most medications by their brand names, including drugs with generic formulations. This may lead to higher health care costs by promoting the use of brand-name products when generic alternatives are available.

Key words

drug labeling drug industry prescriptions, drug drugs, generic names prescription fees ambulatory care 

Notes

Disclaimer

The views expressed in this manuscript are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs.

Acknowledgments

The authors thank Daniel Bertenthal, MPH and Saunak Sen, PhD for their assistance with data management and statistical analysis, Priya Kamat, BA for her help investigating drug approval histories, and Kirby Lee, PharmD for his careful review of the manuscript.

This work was supported by a VA Health Services Research and Development Research Career Development award (Dr. Steinman), by grants from the National Institute on Aging (AG00912) and the John A. Hartford Foundation (2003-0244) (Dr. Landefeld) and from the National Institute on Arthritis and Musculoskeletal and Skin Disease (AR02203) (Dr. Chren), and by support from the HSR&D Research Enhancement Award Program at the San Francisco VA Medical Center (all authors). Drs. Landefeld is a Senior Scholar in the VA National Quality Scholars Program. None of these sponsors had any role in the study design, methods, analyses, and interpretation, or in preparation of the manuscript and the decision to submit it for publication.

Author’s Contributions

Study concept and design (MAS), acquisition of subjects and data (MAS), analysis and interpretation of data (all authors), preparation of the manuscript (MAS), and critical review of the manuscript (all authors). Dr. Steinman had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Copyright notice

All of the authors are employees of the United States government and cannot transfer copyright rights for this manuscript to the publisher.

Potential Financial Conflicts of Interest

The authors have no financial conflicts of interest with products discussed in the manuscript.

References

  1. 1.
    Haas JS, Phillips KA, Gerstenberger EP, Seger AC. Potential savings from substituting generic drugs for brand-name drugs: medical expenditure panel survey, 1997–2000. Ann Intern Med. 2005;142:891–7.PubMedGoogle Scholar
  2. 2.
    Banahan BF, 3rd, Kolassa EM. A physician survey on generic drugs and substitution of critical dose medications. Arch Intern Med. 1997;157:2080–8.PubMedCrossRefGoogle Scholar
  3. 3.
    Mott DA, Cline RR. Exploring generic drug use behavior: the role of prescribers and pharmacists in the opportunity for generic drug use and generic substitution. Med Care. 2002;40:662–74.PubMedCrossRefGoogle Scholar
  4. 4.
    Suh DC. Trends of generic substitution in community pharmacies. Pharm World Sci. 1999;21:260–5.PubMedCrossRefGoogle Scholar
  5. 5.
    National Center for Health Statistics. Public use micro-data file documentation, National Ambulatory Medical Care Survey, 2003. Hyattsville, MD: National Technical Information Service; 2005. Available at http://www.cdc.gov/nchs/about/major/ahcd/ahcd1.htm.
  6. 6.
    National Center for Health Statistics. Using ultimate cluster models with NAMCS and NHAMCS public use files. Available at: http://www.cdc.gov/nchs/data/ahcd/ultimatecluster.pdf. Accessed 19 May, 2005.
  7. 7.
    Mathews AW. When a drug maker creates a new pill, Uncle Sam vets name. FDA tries to avoid mix-ups, similar monikers, dupes; Bonviva becomes Boniva. Wall Street J. March 17, 2006:1.Google Scholar
  8. 8.
    Hemminki E, Enlund H, Hellevuo K, Laurila R, Turakka H. Trade names and generic names. Problems for prescribing physicians. Scand J Prim Health Care. 1984;2:84–7.PubMedGoogle Scholar
  9. 9.
    Bower AD, Burkett GL. Family physicians and generic drugs: a study of recognition, information sources, prescribing attitudes, and practices. J Fam Pract. 1987;24:612–6.PubMedGoogle Scholar
  10. 10.
    Berberich FR. Cephalosporin trade names. Pediatr Infect Dis J. 2003;22:388–9.PubMedCrossRefGoogle Scholar
  11. 11.
    Caves R, Hurwitz M. Persuasion or information: promotion and the shares of brand name and generic pharmaceuticals. J Law Econ. 1988;31:299–320.CrossRefGoogle Scholar
  12. 12.
    Meredith P. Bioequivalence and other unresolved issues in generic drug substitution. Clin Ther. 2003;25:2875–90.PubMedCrossRefGoogle Scholar
  13. 13.
    Nightingale SL, Morrison JC. Generic drugs and the prescribing physician. JAMA. 1987;258:1200–4.PubMedCrossRefGoogle Scholar
  14. 14.
    Fischer MA, Avorn J. Potential savings from increased use of generic drugs in the elderly: what the experience of Medicaid and other insurance programs means for a Medicare drug benefit. Pharmacoepidemiol Drug Saf. 2004;13:207–14.PubMedCrossRefGoogle Scholar
  15. 15.
    Fischer MA, Avorn J. Economic consequences of underuse of generic drugs: evidence from Medicaid and implications for prescription drug benefit plans. Health Serv Res. 2003;38:1051–63.PubMedCrossRefGoogle Scholar
  16. 16.
    Testimony of the Generic Pharmaceutical Association (GPhA) Before the Subcommittee on Health, House Committee of Energy and Commerce, May 18, 2005. Available at: http://energycommerce.house.gov/108/Hearings/05182005hearing1526/Jaeger.pdf#search=%22generic%20substitution%20utilization%22. Accessed 23 October, 2006.
  17. 17.
    Congressional Budget Office. How Increased Competition from Generic Drugs Has Affected Prices and Returns in the Pharmaceutical Industry. Available at: http://www.cbo.gov/ftpdocs/6xx/doc655/pharm.pdf. Accessed 13 July, 2006.
  18. 18.
    Anton C, Cox AR, Ferner RE. Using trade names: sometimes it helps. Arch Intern Med. 2002;162:2636.PubMedCrossRefGoogle Scholar
  19. 19.
    Schwab M, Oetzel C, Morike K, Jagle C, Gleiter CH, Eichelbaum M. Using trade names: a risk factor for accidental drug overdose. Arch Intern Med. 2002;162:1065–6.PubMedCrossRefGoogle Scholar
  20. 20.
    Accreditation Council for Continuing Medical Education. Standards for Commercial Support. Available at: http://www.accme.org/dir_docs/doc_upload/68b2902a-fb73-44d1-8725-80a1504e520c_uploaddocument.pdf. Accessed 13 July, 2006.

Copyright information

© Society of General Internal Medicine 2007

Authors and Affiliations

  • Michael A. Steinman
    • 1
  • Mary-Margaret Chren
    • 2
  • C. Seth Landefeld
    • 1
  1. 1.Division of GeriatricsSan Francisco VA Medical Center and the University of CaliforniaSan FranciscoUSA
  2. 2.Department of DermatologySan Francisco VA Medical Center and the University of CaliforniaSan FranciscoUSA

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