Virtually all doctors are worried that patients aren’t filling their prescriptions. In addition to not filling Rx’s, physicians are most concerned about patients’ skipping doses, splitting pills, discontinuing other treatments, sharing prescriptions, and taking expired meds.

Physician survey on generic drug use, a survey from Epocrates, the clinical decision support company.

As the chart shows, doctors’ choices to prescribe generic drugs are often driven by their patients. In one out of 4 instances, physicians say either the patient prefers a generic or the patient asks for a generic drug.

In 1 in 5 doctors, they “always” prescribe generics if available.

Doctors are increasing their use of generics in prescribing:

  • 58% of physicians say more patients have been asking for generic medications in the past six months.

  • 55% of physicians say they’re writing more prescriptions for generic medications than they did last year.

  • Just over half believe that generic drugs are clinically equivalent to brand-name drugs; 42% believe that equivalence ‘depends on the medication.’

The most prevalent source doctors use for identifying generic alternatives to brands is mobile reference (remember, this is a survey among Epocrates-using physicians), followed by online drug reference, pharmacist recommendation, and health plan information (equally split between online and offline).

The survey polled 705 physicians who are registered with Epocrates and was completed in January 2009. Their specialties included primary care, cardiology, psychiatry, oncology, gastroenterology, rheumatology.

Health Populi’s Hot Points: The key finding in this survey is that patients are preferring and requesting generic drugs. We know that 67% of prescriptions were filled with generic drugs, based on data from Micah Hartman and his colleagues from the Centers for Medicare and Medicaid Services reported in the January/February 2009 edition of Health Affairs. Hartman’s team points out that generic growth significantly slowed down drug cost increases.

What hasn’t been clear underneath that number is that consumers are requesting and keen to know more about generic drugs. Based on Epocrates’s study, the top two reasons doctors prescribed generic drugs in the past year were because patients asked about them or actually preferred them to branded drugs.

This is surely a consequence of both Medicare Part D donut-hole fiscal management on the part of seniors, as well as consumers covered by drug benefit plans who have higher copays for second and third-tiered prescription drugs. Furthermore, more Americans are familiar with the low-cost or even “free” drugs (as in the case of antibiotics this season) offered by Big Box retailers, grocery and pharmacy chains.

The era of cheap drugs is upon us, and consumers’ expectations is that more will follow. That will certainly be the case in this year of the “patent cliff.”

Epocrates asked one final question: “What healthcare technology do you believe helps you save patients the most money?” Physicians said,

1. Electronic formulary reference
2. Electronic medical record
3. ePrescribing.

All 3 of these technologies will further drive physicians toward generics, and the applications are all growing in market penetration.

So don’t only expect the impact of the patent cliff; be on the lookout for technologies that will have the impact of further driving down margins for pharmaceutical manufacturers. Their margin loss is, in the short run, payers’ gains — consumers’, taxpayers’, employers’.