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WASHINGTON, DC
— According to a
new survey
released by the National Consumers League (NCL) today, nearly
three-quarters of prescription drug users would be very
concerned if a drug they were prescribed was switched to another
drug designed to treat the same condition without their doctor’s
knowledge.
Even with their doctor’s knowledge, one in five surveyed are
concerned about the practice, known
as therapeutic substitution,
the dispensing of an alternative to a prescribed medication that
is not chemically or generically equivalent but is in the same
therapeutic class and is used to treat the same condition.
“Consumers are justifiably concerned about the practice of
therapeutic substitution, how it’s done, and who’s involved,”
said Sally Greenberg, National Consumers League (NCL) Executive
Director. “For some conditions and treatments, it may make good
financial or medical sense to swap out one prescription for
another. But, as consumers reported in our survey, it’s
essential for them to be a part of this process, to know their
doctor is aware and supportive of the switch, and to feel
confident that their health and treatment – not financial
incentives – are top priority.”
In an era of skyrocketing health care costs, insurance companies
may turn to the practice of substituting similar (but chemically
different), less-expensive drugs, from the same class.
Advocates are concerned primarily about the practice when it
occurs without the patient’s knowledge, or without discussion
and consent of their physician. However, opinions fall on either
side of the debate, with physician groups expressing concern
over patient safety, and pharmacist groups being more supportive
of the practice as a cost-savings measure and a way to optimize
patient care. In some cases, the substitution can be beneficial
or inconsequential, but in others – especially in treatment of
epilepsy, mental health, and cardiovascular problems – it can be
less effective or pose dangers, especially if done without the
knowledge of the consumer or prescribing physician.
“Without transparency, therapeutic substitution could introduce
efficacy or safety issues, including unknown drug interactions
and potentially serious health consequences. It may evoke
confusion or fear on the part of patients already feeling
frustrated by a failing health care system,” said Greenberg.
The online survey of 1,387 adults aged 18 and older who have
filled a prescription in the past year, which was conducted by
Harris Interactive® for the NCL between August 25 and
September 2 of this year, revealed that most consumers are not
aware first-hand of therapeutic substitution, but they have
objections and concerns about how and when a prescription drug
should be swapped for another.
NCL released the survey today and announced a public education
campaign to educate consumers about the practice of therapeutic
substitution at its Web site, www.nclnet.org.
New resources
help explain the practice and empower consumers to ask the
questions necessary to feel comfortable and in control of their
health care. For an executive summary and full copy of the
survey, visit
www.nclnet.org/health/therapeutic_substitution.pdf. The
survey also polled a sample of statin users to test the
awareness of patients taking medications that might be impacted
by therapeutic substitutions. The views of this group largely
mirrored those of the general population.
Survey Highlights
Consumers concerned about therapeutic substitutions that don’t
involve doctor
·
Overall, prescription drug (Rx) users would be very concerned if
a drug they were taking was switched to another drug in the same
class without their doctor’s knowledge or consent.
·
Nearly three-quarters (70 percent) would be very or extremely
concerned if their prescription or had been changed without
their doctor’s knowledge and consent for a different medication
meant to treat the same condition. And 77 percent strongly
oppose the practice without the consent of the prescribing
doctor or patient.
Consumers’ experiences with therapeutic substitution less than
satisfactory
Of
those who reported experiencing therapeutic substitution for
themselves or a family member, 33 percent say that they (or
their family member) did not have their doctor consulted before
the substitution occurred, and two-thirds (66 percent) say that
they/their family members were not consulted about the switch.
Nearly half (47 percent) were dissatisfied (or their family was)
with how the process occurred and report that this substitution
did not result in lower pocket costs. Only a third (34 percent)
felt that the substituted medication was just as effective as
the original medication.
Consumers don't know much about therapeutic substitution, but
believe it happens frequently
·
66
percent of Rx users surveyed have never heard of the practice of
therapeutic substitution. 10 percent of Rx users report that
they personally experienced therapeutic substitution of their
medication in the past two years, and 9 percent said that a
family member experienced it.
·
When
respondents were given a description of therapeutic substitution
(“replacing the prescribed drug with a chemically different drug
(not just generic version of the branded prescribed drug)”), the
vast majority of Rx users said they believe therapeutic
substitution is occurring at least sometimes in the U.S. (84
percent), without informing the patient (68 percent) or the
prescribing physician (59 percent).
Consumers are open to therapeutic substitution, but certain
factors determine their comfort level
·
Rx
users are most likely to consider switching to a different
medication if their physician felt that the two were
interchangeable (57 percent).
·
A
letter from the insurer may not put consumers at ease, but it
would evoke communication: only 19 percent of Rx users say they
would consider switching to a different medication meant to
treat the same disease if their insurance company sent a letter
recommending this change, but receiving such a letter would
inspire 71 percent of Rx users to have a conversation with their
doctor about a less expensive alternative drug.
·
Nearly a third (31 percent) of Rx users say they would consider
switching medications if their pharmacist called to discuss an
alternative medication.
·
68
percent of Rx users would oppose insurance companies offering
incentives to physicians for switching patients to lower cost
alternatives
·
73
percent of Rx users would oppose insurance companies offering
incentives to pharmacists to switch patients to lower cost
alternatives |
