Newspapers / The Guilfordian (Greensboro, N.C.) / April 1, 1980, edition 1 / Page 10
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GUILFORDIAN, APRIL 1, 1980, Survey reveals generics cheaper By Karen Winstead and Linda Biggs Students in IDS 401, The Drugged Society, conducted a survey of Greensboro pharma cies as part of a class project to compare prices of generic and brand name drugs. The study was undertaken to determine if there is a pattern in drug pricing (specifically if generic drugs are cheaper than brand name products), to examine the arguments concerning generic substitution, and to find out how doctors and pharmacists view the new generic substitu tion law. On June 8, 1979 House Bill 818, an act to provide drug product selection by pharma cists, was ratified by the North Carolina state legislature, ef fective January 1, 1980. This new law allows a pharmacist to substitute a "drug product which has the same established name, active ingredient, strength, quantity, and dosage form and which is therapeutical ly equivalent" (a generic) for the drug product identified in the prescription (usually a brand name). This law also stipulates that a physician may deny generic selection at his own discretion. On the bottom of the new prescription forms are two sig nature lines, one stamped "dis pense as written", the other "product selection permitted". This allows the physician to instruct the pharmacist as to what type drug should be pre scribed. If he/she signs for product selection, then the pharmacist may substitute a generic, if its price to the purchaser will be less than that of the brand name. To conduct the survey, phar macies in the city of Greensboro were selected according to eco nomic area. Two pharmacies were chosen to represent each of the following income areas: low, low/middle, middle, high/ middle, and high. This was done to compare drug prices in Equanll Meprobromata Darvon Oolana Deltasone Prednisone Qulnamm Quinine Sulfate STORE NAME la. Ib. 2a. 2b. 3a. 3b. 4a. 4b. INCOME LEVEL White Oak SB.OO $3.00 $4.95 $3.50 $2.49 $2.49 $10.25 $7.50 Low Drug Company Fairvlew Pharmacy $13.00 $6.50 $5.75 $4.55 $3.25 $3.25 $10.25 $7.20 Low Coliseum Home $10.50 $3.75 $5.50 $3.50 $4.25 $2.85 $9.50 NGS Low-middle Drug Store Bessemer Pharmacy $3.85 $6.30 $4.70 $5.30 512.15 $8.07 Low-middle Buchanan's Drug $11.30 $9.00 $6.00 $3.00 $3.00 $2.60 $11.30 $7.20 Middle Store K-Mart Discount Store $9.90 $2.40 $3.50 $4.00 $2.60 DNP $9.75 NGS Middle Country Park $8.85 $4.85 $5.40 $4.25 $3.95 $3.15 $9.80 NGS Upper-middle Pharmacy Edmond's $11.45 $5.00 $6.55 $4.40 $3.60 SIO.OO NGS Upper-middle (Friendly Rd.) Eckerd's $9.00 $3.00 $5.60 $2.74 $2.68 $2.29 $10.49 NGS High (Friendly Ctr.) Revco/Guilford $9.18 $3.84 $4.49 $2.59 $2.75 $2.75 $9.83 NGS High College Drug Store (Guilford College) AVERAGE $10.13 $4.52 $5.40 $3.72 $3.39 $2.77 $10.33 $7.49 Key: NGS -- does not stock generic substitute; a = brand name drug; b = generic drug DNP -- does not price over the telephone —price not given Interpretation: Drug stores located in high income level areas of Greensboro sold generic drugs for the least amount, while drug stores in the low-middle and low level areas of in come sold generic drugs at higher prices. Brand name drugs were the least expen sive at drug stores located in the middle income areas and were the most expen sive in low-middle income areas. Overall, the price of both generic and brand name drugs was the most expensive in the low and low-middle income areas and the least expensive in the high and middle income levels. PAGE TEN different parts of the city and to try to eliminate any bias that might be attributed to choice of pharmacy. The pharmacies were both chain-operated and indepen dently-owned. Each of the eight surveyors was given a brand name drug and its generic equivalent, along with the names and telephone numbers of the ten pharmacies to be called. During the week of January 20, the surveyors telephoned each pharmacy on their list and asked the price of their particu lar drug. They did not tell the pharmacists that they were taking a survey because they believed that information would be more freely given if phar macists were not informed of our study. In spite of this, responses varied from pharmacist to pharmacist. Some were reluc tant or refused to give prices over the phone; some demand ed to know who was requesting the information; others said they did not stock generic equivalents. However, because of the number of drugs and pharma cies investigated in the survey, they were able to collect enough information to support the con clusion that generic substitutes can indeed save the customer money. In addition to the survey, the surveyors interviewed doctors and pharmacists to get an inside look at the subject of generic versus brand name drugs. They found out that three out of four of the persons interviewed were in favor of generic substitution. The one who was against using generics "in general" ex pressed concern over their safe ty and therapeutic effective ness. This comes as no surprise when one considers that certain large drug companies have been known to use scare tactics to keep doctors and pharmacists from requesting generics in- —Si ' —— ASflroj Jbum 1 stead of brand name drugs. For example, some large drug firms are focusing on a few isolated cases in which generics have been found to be inferior to the brand name drugs. These same drug companies have also tried to convince the public that generics are not safe or effec tive and that the generics drugs are not manufactured by relia ble pharmaceutical houses. The fact is that the same company will often manufacture both the generic and its brand name equivalent, or it may manufacture a drug and sell it to different companies which then market it under different names. In any case, almost all studies have shown that gener ics are equivalent to brand name drugs. In fact, many of the top experts in the phar maceutical and medical fields support the use of generic drugs. Not only are generics equiva lent to brand name drugs; their use can mean a 35-50% saving to the customer. Many generics are maintenance drugs that people with, for example, heart conditions and blood pressure problems take for extended periods of time. For these people, the savings could be as high as 50%. Furthermore, since generics are less expen sive than brand name products at wholesale, a pharmacist can purchase them at a lower cost, thereby reducing his/her inven tory and passing the savings on to the customer. The pharmacist would be guaranteed a profit because of the way prescription price is calculated. There are basically two ways a pharmacist can determine price. One is by adding a fixed service; another is by adding a percentage of the wholesale price. Why then are some physi cians and pharmacists reluctant to administer the generic in stead of the brand name? In one interview, a student was told that the pharmaceutical indus try spends huge amounts of money promoting and advertis ing brand name drugs by dis pensing throughout the coun try, and by employing sales representatives. Several of the pharmacists interviewed mentioned undo cumented cases in which some drug firms will reimburse a doctor or pharmacist for pre cribing or buying their brand name drugs. In addition, some pharmacists and doctors have invested their money in drug company stocks and are more than willing to prescribe the brand name drugs of that particular firm. The new generic substitution law was designed to help the consumer save money, but is this guaranteed to happen? Certain deficiencies in the law and in the new prescription forms could actually inhibit substitution. First, the law does not pro vide for a formulary. A formu lary lists drugs by their generic or chemical names, and all of their therapeutically equivalent brand name counterparts. A formulary of the most common ly prescribed drugs should be available to every doctor and pharmacist in the state to use as a guide for decisions on drug prescription. With this constant reminder of which drugs may be interchanged, both the phy sician and the pharmacist would be more inclined to try the often "forgotten" generic. Second, a price list of the 100 or 150 most often prescribed drugs should be prominently displayed in each pharmacy to inform the customer that there are differences in drug prices. If there is any doubt in the mind of the customer as to a generic's effectiveness, he/she could, of course, ask the pharmacist (who would then consult the formu lary). The most significant fault with the law as it stands lies in the design of the prescription form. The form has two signa ture blanks, one which permits substitution and one that speci fies a particular drug and only that drug. The problem is that the "dispense as written" line is on the right side of the form. This is also the side where old single line prescription form was signed. Force of habit could lead a majority of physicians to sign automatically on the right. Fur thermore, a 1977 study has shown that when given a choice, a doctor will prescribe the brand name drug 78% of the time. Another study revealed that brand names were dispensed 3.6% of the time when a single line form was used. America has come a long way since the 1950s when anti-sub stitution laws were enacted to protect the public against poorly tested drugs and shoddy manu facturing practices. Drugs are now tested rigorously before marketing to ensure their purity and effectiveness. A customer can purchase a generic drug with the same peace of mind that he/she has when buying the more expen sive brand name product. But, if the test of time shows that in North Carolina the proportion of prescription drugs sold are still overwhelmingly brand names, then it will be necessary for the informed consumer to demand these changes in the law for the sake of the unwary purchaser. The students who conducted this survey (Mike Tornell, Cla rice Stadler, Karen Winstead, Marty Block, Keith Lohmann, Malcolm Oliver, Keith Green,a and Linda Biggs) would like to express their gratitude to the North Carolina Public Research Interest Croup for supplying background information.
The Guilfordian (Greensboro, N.C.)
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April 1, 1980, edition 1
10
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