Are private physicians more likely to veto generic substitution of prescribed pharmaceuticals?

Abstract

Physicians'decisions whether or not to veto generic substitution were analyzed using a sample of 350,000 pharmaceutical prescriptions from the county of Västerbotten, Sweden. The primary purpose was to test if physicians working at private practices were more likely to oppose substitution than county-employed physicians working on salary. It was found that private physicians were 50-80% more likely to veto substitution. Also, the probability of a veto was found to be increased as patients'copayments decreased. This might indicate moral hazard in insurance, though other explanations are plausible.

Knowledge and attitudes of the pharmacists, prescribers and patients towards generic drug use in Istanbul-Turkey

“…Inaccurate or insufficient knowledge about generics can cause ineffective and unsafe treatment. This situation can also lead to a high cost, contrary to expectations 2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18…”

“…Both in developed and developing countries, health insurance agencies, health authorities and governments have suffered from pharmaceutical expenditures that has risen rapidly especially in the last two decades 2,3,4,5,10,11,12,13,14,15. Substitution of generics for brand-name might be an alternative way to reduce drug expenditure.…”

Parallel imports and a mandatory substitution reform: a kick or a muff for price competition in pharmaceuticals?

“…Once included in the pharmaceutical benefits scheme by LFN, applications for price increases are required to price of the more expensive prescribed drug. Physicians only prohibited substitution for a few percent of the prescriptions (Granlund, 2009). include motivations for the price increase as well as information about the prices and treatment costs of comparable drugs (RFFS 1996:31, LFNFS 2003. If the requested price is the same as or less than the price of the most expensive substitutable product in the reference group, no motivation is needed and the price increase is always accepted (LFNAR 2006:1).…”

The Effect of Pharmacies’ Right to Negotiate Discounts on the Market Share of Parallel Imported Pharmaceuticals

“…This indicates that the reform has increased the probability that pharmacies inform consumers about their right to buy other substitutes than the prescribed product or the cheapest available substitute. This paper relates to many studies on determinants of choices between medically equivalent pharmaceuticals (Leibowitz, Manning, and Newhouse 1985;Hellerstein 1998;Coscelli 2000;Mott and Cline 2002;Granlund 2009) even though these studies have focused on the choice between brand name and generics and primarily analyzed the role of physicians. Using survey data on 3,000 prescriptions from pharmacies in a Midwestern state, Mott and Cline (2002), however, found that pharmacy random effects accounted for 43% of the variation in the occurrence of generic substitution.…”