Many people have heard the proverb, "Do as I say and not as I do." The truth of this maxim is found in the way people behave about generic medications. Most Americans say generic drugs are a better value than branded drugs. However, when researchers look at new prescriptions, they find most are for brand-name drugs.

What is the difference between a generic drug and a brand-name drug?

A generic drug is a medicine that has the same active ingredient as a brand-name drug. The United States Food and Drug Administration (FDA) regulates generic drugs. The FDA requires proof that the generic drug to behaves in the human body in the same way as the brand-name drug. The only important difference between a generic drug and the corresponding branded drug is cost. The generic drug is almost always less expensive.

What do Americans believe about generic medications?

Researchers at Harvard Medical School asked patients about their beliefs about generic drugs. The researchers analyzed responses from 1047 patients with health insurance. The results revealed a paradox.

Among insured patients:

• 94% said drug costs are too high
• 87% agreed that Americans spend too much on prescription drugs
• 94% believed that generics are less expensive than brand-name drugs
• More than 70% agreed generic drugs are a better value than branded drugs
• 56% agreed that Americans should use more generic drugs
• But only 37% agreed they would rather take generics than branded medications

http://www.ncbi.nlm.nih.gov/pubmed/19276015

Why do Americans believe generic drugs are good for other people but not OK for themselves?

The Harvard researchers asked probing questions to find out why patients preferred branded drugs for themselves.

Do patients believe brand-name drugs are more effective? Only 30% thought branded drugs were more effective than generics. In other words, most patients believe branded and generic drugs are equally effective.

Are patients concerned about adverse effects from generic drugs? Less than 10% believed that generics cause more side effects than brand-name drugs.

It does not appear that patient perceptions about effectiveness or safety drive decisions toward brand-name drug prescriptions. http://www.ncbi.nlm.nih.gov/pubmed/19276015

Are patients afraid to ask their physicians for generic prescriptions? 67% said they were comfortable asking their physician to substitute a generic for a branded medication.

http://www.ncbi.nlm.nih.gov/pubmed/19276015

If patient perceptions and fears do not motivate decisions in favor of branded drugs, then what does motivate these decisions?

The Harvard researchers evaluated 5,399 new prescriptions where there was a brand-name or generic choice. When a choice was available, the prescriber chose a brand-name drug for 77% (4137/5399). The researchers looked for conditions that predicted brand-name prescriptions. Some predictors related to the physician while others related to the patient. Two types of physicians were more likely to prescribe brand-name drugs: medical subspecialists and obstetrician-gynecologists. Primary care physicians were most likely to prescribe generic drugs. If a patient had low household income, then the patient was most likely to receive a brand-name prescription. Patients with wealthy household incomes most often received generic prescriptions.

http://www.ncbi.nlm.nih.gov/pubmed/17647066

The research results revealed another paradox. The low income patients with least ability to pay for expensive medications are the most likely to get prescriptions for brand-name drugs. The researchers speculated that doctors started low income patients with free samples of expensive brand-name drugs. When the poor patient returned for a follow-up visit, the doctor forgot to switch to a generic equivalent drug.