January 25, 2008 
Another WSJ article that I caught on the plane ride home last night was about Doctors Paid To Prescribe Generic Pills. When I read the WSJ Health Blog about this, I was shocked by the comments. It would appear that the blog is followed by people that don’t believe generics make sense. That perspective is a little outdated now that most therapy classes have one of the most popular drugs available as a generic.
Yes, in some cases there have been minor improvements, but I don’t think anyone can (with a straight face) get up and talk about how Nexium is clinically superior to generic or OTC Prilosec (see general comments about category of PPIs). There has been numerous research showing that the probability of having success with any anti-depressant is the same regardless of what drug you begin therapy with (so why not start with a generic). And, generic drugs have been around for a long time so all their side effects and drug-drug issues are well known and documented. There has never been a generic drug pulled from the market.
Here was what I posted there.
Wow! There seem to be a lot of the glass is half-full people out here. What if the generic (which often was the most prescribed drug in the class before the patent expired) is clinically appropriate.
There are 10,000+ drugs out there. Physicians can’t be expected to know and monitor the comparisons on each one. That is what technology and pharmacists are focused on. So, if companies can identify a way to help the patient save money, what’s wrong with switching drugs.
The exact process of paying the physician seems suspect, but some incentive to reward them for their time (perhaps regardless of outcome) makes sense. You are asking them to pull the patient’s file, look at a different drugs and perhaps some clinical information provided by the payor, and determine if a switch makes sense.
Physicians today rarely have an incentive linked to drugs so why not prescribe the most expensive, most heavily sampled, most advertised drug. That’s the easy path.
I don’t disagree that more sharing of the benefits might make sense, but the market has changed. Generics and therapeutic conversions can make a lot of sense.
The issue of incentives is a broader one. Paying physicians directly per switch seems a little suspect. But, incenting them to save money for plans and patients makes a lot of sense. But, like any incentive system, it has to be balanced. Health outcomes balanced with cost management. Patient satisfaction balanced with simplicity of the process. I won’t get on my soapbox here. Metrics are difficult, but the system today doesn’t always align the parties correctly.
Enabling Healthy Decisions 
With the issue of paying doctors to switch patients on branded meds to generics deviates away from objective therapeutic decision making by that doctor. Managed Care Companies are doing this as an unrealistic response to the lucrative inducements available to doctors by pharma companies.
Both are wrong tactics to implement. The doctor’s patient, when this happens, is viewed as a financial prospect which distances this physician from his primary objective with thier patient, which is the authentic restoration of thier health. So inducements are a very corruptive, yet apparently progressive practice which further deteriorates public health and the health care system in general.