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Doubts exist regarding efficacy, compliance with generics
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One of my long-term patients recently presented with a corneal erosion. With a 20-year history of profound dry eye and anterior basement membrane dystrophy, this was not her first episode. It was, however, her first in many years. It seemed we had finally found an effective management strategy for her recalcitrant corneal erosions – lid hygiene, lubrication, omega-3s and doxycycline.
As I carefully looked over her history, I could not help but notice the doxycycline was missing. When asked, she apologetically confided having discontinued it due to cost. A bit perplexed, as I knew she was on a generic, I asked how much the drug cost. Her 3-month supply, which traditionally cost around $100, had increased to just under $1,000.
Certain that she was confused, I contacted her pharmacist only to find … she was correct. The price of her delayed-release doxycycline hyclate 100-mg tablet had skyrocketed. Apparently, a consolidation of generic manufacturers plus increased doxycycline prescribing plus the public’s insatiable appetite for generics had created the perfect storm. With only a few generics and one branded manufacturer in the game, prices took off. In short, it was Economics 101. Demand exceeded supply.
Michael D.
DePaolis
Like you, I get it. In a country where roughly 17% of our gross domestic product, or $2.9 trillion annually, is tied up in health care, something has got to give. As many of you know, I have used this editorial column to make my position loud and clear: if we are ever to curtail health care costs in this country, it is going to take a concerted effort among all stakeholders – drug companies included.
Fortunately, for the better part of the past decade, generics have been a “feel good” story, costing roughly 25% of their branded counterparts and accounting for upwards of 80% of prescriptions filled in the U.S. today. But with so many people using generics, will the cost savings endure? Perhaps not. In fact, in an October 7, 2014, article in the New York Times, Elisabeth Rosenthal aptly noted, “The prices of some generic drugs have soared more than 1,000% in the last year.”
From a clinician’s perspective, the trend is particularly alarming. While we have come to accept generics, certain lingering doubts remain. Is a generic truly 100% bioequivalent? If so, does its bioequivalence translate into equal bioavailability? And, if so, are all generics created equal, especially given that pharmacies can change manufactures from refill to refill? These are critical questions, especially in conditions such as glaucoma, where the stakes are high and we rely so heavily on drug efficacy and compliance.
In this issue of Primary Care Optometry News, I encourage you to take a look at our feature article, “Optometrists prefer branded to generic glaucoma drugs”. While drug cost is certainly critical to compliance, other variables are also important. And while generic drug savings definitely influence patient compliance, they do so only if patient cost remains low. Just ask my patient.