Doctors, Insurance Firms Duel On Generics

(AP)  All the doctors had to do was show up, enjoy a free dinner at an elegant Rochester, N.Y., area restaurant specializing in steaks, chops and top-shelf wines, and pocket $100 on the way out the door.

Health insurance companies had invited the physicians to hear a pitch about the benefits of prescribing generic drugs instead of their pricier, name-brand competitors.

Meet the flip side of a concern about corporate influence in the doctor's office that's been criticized - often stridently - when the pharmaceutical industry entices doctors to prescribe brand-name drugs. Under pressure, that industry has since reined in its promotional efforts.

But insurance companies are allowed to push doctors toward cheaper prescriptions, frequently by offering the physician a form of bonus, a cut from the savings that insurance companies get when doctors prescribe generic drugs.

For example, Independent Health, a Buffalo, N.Y.-based insurer, offered doctors who prescribe 70 percent or more generic prescriptions in a month a bonus of 50 cents per patient per month. A doctor seeing 500 patients per month who meets the 70 percent minimum can collect $3,000 a year.

"On either side you've got corporate bottom-line interests putting pressure on physicians who should be putting patients first," said Dr. Jean Silver-Isenstadt, executive director of the National Physicians Alliance, an industry organization that prioritizes patient interests.

John Rodgers, executive vice president and chief marketing officer for Independent Health, said the incentive program rewards doctors for prescribing generics when possible - but it doesn't punish them if they don't.

"Our plan doesn't agree to force people off of a drug if a person makes a personal choice they can continue that drug with a higher copay," he said.

Some states want to more closely monitor the relationship between insurance industry representatives and doctors. In Massachusetts, a pending bill would regulate incentive plans between insurance carriers and providers. A Michigan proposal would ban financial incentives in exchange for prescribing a generic medication. That measure would allow insurance companies to compensate doctors for the time it took to evaluate whether a switch was best for the patient.

In New York, state Sen. Jeffrey Klein introduced legislation that would prevent insurance companies from offering physicians incentives. A grandfather clause would require HMOs to continue providing brand-name drugs to patients already benefiting from it. But none of these bills have gotten serious traction in state legislatures.

Last year, the American Medical Association warned that it considered the bonuses kickbacks and said doctors who accept payment from an insurer for switching a patient from a brand name to a generic drug could potentially face criminal and civil liability under federal statutes.

And caught in the middle, physicians warn that when a medical decision is taken out of a doctor's hands, it can hurt patients, such as 77-year-old Emmett Curran of Lynn, Mass.

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[docpeter1953]

Wouldn''''t you think that after the patent period expires, the original manufacturer could maintain a cost level equal to or less than the generics? Or is it true that they are not "equivalent"?

Posted by drivelphobe at 03:24 PM : Oct 30, 2008
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Try this little experiment for yourself. Go to Wal-Mart, K-Mart, Costco, Walgreen''s CVS, whatever pharmacy you want. Get a bottle of Advil and a bottle of the store brand. Read the labels and open both at home. They are the identical medications. One you pay $10.00 for and the other you pay $7.50 for. they are the same. Ask the pharmists what the difference is and he will tell you none, if he is honest.

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Could someone invent a system of non-synthetic drugs that can be prescribed without influencing the Doctor''''s bank account?

Posted by baileycc at 02:41 AM : Oct 31, 2008
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yes they are already here. They are called naturacueticals. They work, but they take longer to work, and most need to be taken regularly. And, alas, the FDA and the deep pockets of Big Pharma is there at every turn to prevent you from purchasing these.

Now I will agree with them on one point, these naturals have very little control, but shouldn''t the FDA make it mandatory for the producers to ensure that what they are selling meets some standard?

[hennighg]

Oh, well, now I''ve heard enough. Sick people, if they have any patriotism at all, will pay the doctors AND the insurance companies AND the medical companies just as much as they can. What do we need with sick people anyway? If they only gave more money, they wouldn''t be sick, just hungry. But at least they wouldn''t be sick.

[baileyccc]

Could someone invent a system of non-synthetic drugs that can be prescribed without influencing the Doctor''s bank account?