Physician influence on generic versus trade-name prescription decisions

Hellerstein, J. (1998). "The importance of the physician in the generic vs. trade-name prescription decision." The RAND journal of economics, 29 (1), pp. 108-36.

The goal of this study was to determine the importance of physicians in the process that determines whether patients will receive generic or trader-name ("name-brand") drugs.

This was part of a move to determine what factors, if any, were used by the physician and/or patient in determining which prescription to prescribe/use. Ultimately, such research could be used for patient advocacy or, conversely, prescription marketing, though the author does not mention these applications.

The time period covered by the actual study was very narrow; the data used was collected by the author in a survey distributed to patients and their physicians. Thus, the study covers only an unspecified time period shortly before the publication of the study, likely a time period during 1997. The author does rely on data from previous years in her introduction, however, citing changes in the prescription rates of generic and trade name drugs during the 1980s and into the 1990s. In general, the author found that despite the sudden emergence and popularity of generic drugs in 1984, prescription rates as of 1989 reflected a very limited use by physicians of specifying generic prescriptions for their patients. Despite the fact that seventy-percent of the drugs prescribed in 1989 had generic versions as well as trade name drugs available (making them so-called "multisource" drugs), only thirty-percent of prescriptions specified generic drugs despite significant cost benefits to patients.

The study attempted to determine the cause of this apparent preference for trade name drugs. In brief, its findings suggested that patient conditions, temperaments, and other patient-related variables were of negligible and inconsistent effect on the prescription of generic drugs, but that physicians were of immense importance in making the determination between generic and trade name prescriptions. The study was unable to determine -- did not really attempt to determine, it must be said -- what caused physicians to tend to write down trade names for drugs rather than generic varieties. Thus, there was little new information present for me in this article. Having picked up and filled several prescriptions myself, I have grown used to asking the pharmacist rather than the physician for a generic prescription. I understand and appreciate the importance of backing up this anecdotal evidence with a scientific study, but the actual findings of the study, though well proven, are of little revelatory value.