Reasons for Underutilization of Generics by Ophthalmologists

Ophthalmologists prescribe a larger percentage of brand-name medications relative to generics than other specialty, according to an analysis of Medicare Part D claims data published in 2018.

Results of a survey of 92-board certified ophthalmologists in Midwest shed some light on why generics may be underutilized in ophthalmology. Published online yesterday on the website for the journal of Ophthalmology and Therapy, the results show that about a fifth (21.7%) of the respondents believe that generics have additives that vary from batch to batch and about a third (32.6%) believe that generics get switched based on pharmacy contracts and “there is variation between generics that makes me uncomfortable for inconsistent treatment.”

Overall, a little bit more than half (55%) of the respondents had no reservations about prescribing a generic drug and a little bit less (44%) had at least one qualm.

The research team led by Jamie Dietze, M.D., at the West Virginia University Medicine said in their paper that their analysis of the survey results identified four variables that tracked with reluctance to prescribe a generic:

• Severity of the disease. Twenty of the 92 respondents (30%) indicated that if the eye disease is more severe, they prescribe a brand-name drug.
• “Anecdotal feelings” that patient outcomes are affected by whether the treatment is with a brand-name drug or a generic.
• A personal preference for treatment with a brand-name drug when asked about a hypothetical scenario in which they were the eye disease patient and the brand-name drug and the generic were both free. In such a circumstance, 40 of the 92 (43.5%) of respondents indicated a preference for a brand-name drug.
• A personal preference for treatment with a brand-name drug when asked about a hypothetical scenario in which they were the eye disease patient.

The survey also found that a sizable fraction of the ophthalmologists felt they didn’t know much about the price differences between generics and brand-name drugs.

“Our study suggests there may be value in performing randomized clinical trials comparing generics to brand-name medications,” wrote Dietze and her colleagues. “Such trials may help alleviate the concern that brand-name drugs are more efficacious.”

Five state ophthalmology societies (Nebraska, Minnesota, South Dakota, North Dakota, and Wisconsin) and eight private practice group distributed the survey to practicing ophthalmologists for Dietze and her colleagues. All the respondents graduated from residency programs between 1973 and 2018, and they were, on average, 49-years-old.