The use of generic medications from the same class as a brand name drug could save billions of dollars, according to a new study. Researchers from The Ohio State University examined the records of more than 107,000 patients between 2010 and 2012, of which one-third were taking medications within commonly used drugs classes such as statins, proton-pump inhibitors, angiotensin II receptor blockers, and psychiatric medications. Of those, about half were on at least one branded drug, about 75% were on a generic drug, and about one-third were on both.

Nearly $150 billion was spent on the branded drugs, while about $63 billion was spent on generics. If therapeutic substitution of a generic within the same class had been used instead of the branded equivalent, $73 billion could have been saved, including nearly $25 billion in out-of-pocket expenditures for patients.

The drug classes with the highest excess expenditures included statins ($10.9 billion), atypical antipsychotics ($9.99 billion), proton-pump inhibitors ($6.12 billion), selective serotonin reuptake inhibitors ($6.08 billion), and angiotensin II receptor blockers ($5.53 billion).

The authors concluded that although therapeutic substitution is controversial, it offers the potential to save billions of dollars in drug costs without
affecting quality of care (JAMA Intern Med. Published online May 9, 2016. doi:10.1001/jamainternmed.2016.1704).

An accompanying research letter polled board-certified internists about their trust in generic drugs. Skepticism of generics has decreased significantly in the last six years, with only about one in 10 believing that generics are less effective than brand name drugs. The most common variable among generic skeptics was the likelihood to receive information from a pharmaceutical representative (JAMA Intern Med. Published online May 9, 2016. doi:10.1001/jamainternmed.2016.1688).

In an editorial, Joseph Ross, MD, points out the risks of therapeutic substitution, especially when substituting a generic drug for a branded medication within the same class rather than the exact copy of the branded medicine. This requires “wider adoption of systematic protocols, aligned with physician judgment, as to when such substitutions are beneficial and when not. This work is not easy; it requires close collaboration between physicians and pharmacists, but the financial savings will be large.” (JAMA Intern Med. Published online May 9, 2016. doi:10.1001/jamainternmed.2016.2271).