An article published online on May 9, 2016 in JAMA Internal Medicine (ME Johansen and C Richardson. Estimation of potential savings through therapeutic substitution.) presented estimates of “excess expenditure due to branded drug overuse when a lower-cost generic in the same class with the same indication was available” between 2010 and 2012. The “excess expenditure” in the US was $10.9 billion for statins, $6.12 billion for proton pump inhibitors, and $5.53 billion for angiotensin receptor blockers. None of the drugs in any of those drug classes has a narrow therapeutic window. Well-documented therapeutic inequivalence between brand-name and FDA-approved generic products has not been reported for any of them.
Many publications write about drug prices. The Medical Letter is one of the few that tells its readers what those prices actually are. Looking back at our most recent article on Drugs for Lipids, published in 2014 (an update is in preparation), we see that the wholesale acquisition cost for a 30-day supply of generic atorvastatin at the lowest recommended dose was $10.50, compared to $147 for the same amount of Lipitor. Generic simvastatin cost $4.20, compared to $186.60 for Zocor. In our article on Which PPI? published about a year ago, the cost for a month’s supply was $16.30 for generic omeprazole, $218.70 for Prilosec, and (bizarrely) $16.80 for Prilosec OTC. In the 2014 article on Drugs for Hypertension, our table showed that the wholesale cost for 30 days of generic enalapril was $3.00, compared to $135.50 for Vasotec.
Clearly, many clinicians feel more comfortable prescribing brand-name drugs. And for many of us, that is still our prerogative. But maintaining awareness of the existence of generic equivalents and the huge disparities in cost between some of them and their brand-name counterparts seems like a good idea. And one way to do that would be for you and your institution to subscribe to The Medical Letter. You could save billions.