|Dr. O. Kenrik Duru: "Many patients are not aware that there is often a less-expensive alternative to many popular medications that may work slightly differently but have a very similar therapeutic effect." Photo: Getty Images|
Medications are expensive, and even with insurance coverage, patients’ out-of-pocket costs can be hefty. This holds true, as well, for individuals with Medicare Part D, the prescription benefit that subsidizes the cost of medications for about 28-million Medicare beneficiaries. About one-fifth of Part D beneficiaries have out-of-pocket costs that top $100 a month, and some 10 percent are forced to use less medication than prescribed due to financial hardship.
Given that both the government and Medicare beneficiaries must deal with the high cost of medication, there is a need for strategies to reduce those costs. A UCLA-led study points to a simple solution that could result in hundreds of dollars in savings per patient: Instead of brand-name drugs, substitute less-expensive counterparts that have a similar therapeutic effect — a practice known as therapeutic interchange or therapeutic substitution. While about 90 percent of hospitals do it all the time, it is not common practice in outpatient settings in the United States.
“The increase in prescription-drug costs is not sustainable over time, and we need to consider alternative approaches that are more cost-conscious,” says O. Kenrik Duru, MD (FEL ’03), associate professor of internal medicine. “Many patients are not aware that there is often a less-expensive alternative to many popular medications that may work slightly differently but have a very similar therapeutic effect.”
Using 2007 data to identify 50 common medications prescribed in a large Medicare Part D health plan, the researchers compared the cost of the original medications to substitutes and calculated the potential savings. This review included savings for the patient, the health plan and, in some cases, for the government when it was subsidizing the cost. They found that 39 percent of Medicare patients receiving a low-income subsidy and 51 percent of patients not receiving a subsidy were eligible for a generic or therapeutic substitution. For each generic substitution among subsidized patients, the government would save an average of $156 per year. Therapeutic substitutions among subsidized patients would result in greater savings: The government would, on average, save $126 per year, and the health plan would save $305 per year. Patients not receiving a low-income subsidy would save $138 per year for each generic substitution and an average of $113 per year for each therapeutic substitution, and the health plan would save $276 per year.
The researchers note that not every substitution is appropriate for every patient, and they acknowledged that in some clinical scenarios, potential substitutions have already been tried unsuccessfully or may not be appropriate at all.
“Potential Savings Associated with Drug Substitution in Medicare Part D: The Translating Research into Action for Diabetes (TRIAD) Study,” Journal of General Internal Medicine, August 2013