You are correct - in cases where there is a brand-name version of a dug AND also a generic version of the same drug, the generic is usually provided unless the brand-name is specifically requested.

But, the parent post is describing cases where there is a new, brand-name drug that fills the same niche as an existing generic. Two different drugs, but often only slightly differing results. MDs often prescribe the newest, assuming it's better than the generic. MDs receive much of their ongoing education about drugs from the pharmaceutical sales reps, so they are bombarded with ads and samples (just as consumers are with ads on TV).

As an aside, my dermatologist has been good about ensuring the costs of any treatments I receive are managed. She's recommended specific pharmacies, brand-name vs generic, and other tips/tricks to reduce the costs. This despite the fact that I don't directly bear any of the costs because I have a decent medical plan.

That is not always a correct assumption. Due to the way some programs like Medicare pay out, doctors are sometimes strongly incentivized to prescribe the most expensive drug.

Ophthalmologists are the usual notorious example, prescribing for macular degeneration. Medicare's reimbursement for drugs administered in-office includes paying the cost of the drug plus an additional percentage.

For macular degeneration, research showed Avastin and Lucentis are basically equally effective. But Avastin is ~$50/dose and Lucentis is ~$2,000/dose. If you're going to get a "bonus" payment equal to a percentage of the cost of the drug, which one would you use?

Lucentis has at times accounted for 10% of the entire Medicare part B drug budget because of this.

My comment was based on the more typical situation, where the physician sends the patient to a pharmacist.

Giving the same (high?) standard of care to patients without regard to their financial resources.

So the generic just doesn't get considered, even though it would be suitable for the patient at much lower costs. This is unrelated to the situation you're describing.

Many ophthalmologists will give the most expensive post surgical drops. When I called one to have him change it, he was like “uh, there’s no substitute.” I thought to myself, “then what did you guys do before these drugs came out a couple months ago?” Example: post cataract surgery people usually get an antibiotic, a corticosteroid, and an anti inflammatory. These generic drugs have been on the market for years. But new ones come out here and there that are hella expensive, we’re talking a copay of $5.00 vs $100+ per eye drop.

Also there are prescribing guidelines called step therapy. For example for diabetes: https://emedicine.medscape.com/article/117853-treatment#d10 doctors will skip the first few steps and prescribe a brand name drug immediately that’s like step 3.

Insurance companies try to stop it by requiring authorization but... I feel like we’re fighting an uphill battle with perverse incentives.

What I found was that a lot of doctors look at the decision from a clinical lens only. Why not prescribe the latest branded product, even if it's only marginally better than the generic? Patients deserve the best, right?

Making a cost vs. benefit trade off wasn't a universal process for many physicians.

I can't really disagree with that logic.

By the way, some of these newer drugs don’t have to be “superior” to be approved, they just have to be none-inferior to current therapy. https://www.raps.org/regulatory-focus™/news-articles/2016/11...

We had a similar corruption here, in Lithuania, until the law has been passed that pharmacist must offer a generic alternative. But there again, world is seen very differently in EU than USA, so I don't expect that to apply on the other side of the pond.

That's surprising. Over here (Germany) the doctor can fill in the name of the brand in the prescription, but unless he ticks a special box you'll automatically get the generic.

Some people will still opt for the more expensive, of course, but where's the incentive for the pharmacist to fill a script for Neurofen RTM with anything other than ibuprofen? Why even is there a special box -- if the generic isn't the same drug (tested, licensed, etc.) it's not a generic. Might as well have a "are you getting a kickback for prescribing this" box?

> Each tablet contains Ibuprofen 200 mg Also contains: Sucrose, Sodium Citrate, talk, Croscarmellose Sodium, Stearis Acid, Titaniu, Dioxide, Silicon Dioxide, Acacia, Carmellose Sodium, Sodiu, Laurilsulphate, Macrogol and Blank Ink(contains Shellac, Iron Oxide Black (E172) and Propylene Glycol) or Opacode S -1 -8152 HV Black (contains Shellac, Iron Oxide Black (E172, Antifoam DC1510 and Soya Lecithin

https://www.boots.com/nurofen-200mg-tablets-16-tablets

to generic ibuprofen:

> Ibuprofen 400mg, sodium starch glycollate, croscarmellose sodium, sucrose, E171, E127 and E211

https://www.chemistdirect.co.uk/ibuprofen-400mg-tablets/prd-...

That's a bold and unfounded claim. Drug makers do not incentivize doctors to write DAW on a prescription.

Forbes and the New York Times have written articles on it. The Affordable Care Act has a provision that requires Doctors to disclose payments.

Empirically, I dated a girl for about 2 years who was a sales representative for a major pharmaceutical company. When I asked about her job she said it was mostly dropping of brochures, swag, free lunches, and holding contests to promote products. Top producers (doctors) received all expense paid trips to medical conferences held in exotic locations or were invited to be paid speakers at said conferences. It was not too different from what the marketers did at the insurance broker I worked for at the time to cater Agents to write their lines.

Your anecdote is about which drugs the doctors choose to prescribe. It has nothing to do with incentivizing doctors to prevent patients from filling generic versions of drugs and forcing them to purchase the brand-name version of the same drug, which is what this thread is about.

I don't know how those reports are generated. Do pharmacies report that information back to pharmaceutical companies? Are they based off of shipments to regions?

They're not out there to make sales for old drugs (drugs that have gone generic). They're out there to make sales for new drugs, which don't have generic equivalents at all.

No pharmaceutical company is going to waste money on sales for drugs that have gone generic, and certainly no pharmaceutical company is going to try and incentivize providers to DAW prescriptions. Aside from being already illegal, even an unscrupulous company wouldn't bother because it'd be a tremendous waste of money.