Effects of a physician office generic drug sampling system on generic dispensing ratios and drug costs in a large managed care organization.

Abstract

Greater use of generic drugs, particularly as measured by the generic utilization or dispensing ratio (GDR), is an effective means of managing care by attaining the same clinical outcome as brand drugs but at lower cost. Health plans encourage members to use generic drugs through copayments that are lower than for brand drugs. Encouraging physicians to prescribe generic drugs in therapeutic selection continues to be an opportunity for health plans to produce drug cost savings without compromising safety or efficacy. To determine if the addition of an automated generic drug sampling system in primary care physician offices would increase (1) the GDR of the sampled therapeutic categories and (2) the overall GDR. To encourage prescribers to increase their use of generic pharmaceuticals, this managed care organization of 2.3 million members with pharmacy benefits, who represent about two thirds of approximately 3.5 million total health plan members, collaborated with a vendor that developed an automated generic medication sampling intervention that takes place in the physician's office at the point of care. The generic sampling system (kiosk) included 21 distinct generic drugs in 36 variations of dose and strength. To isolate the effect of the generic sampling intervention from the general trend of greater generic drug use, we compared physicians participating in the generic sampling program with all other network physicians. Because formal statistical testing of program outcomes was precluded by incomplete physician data, we performed a descriptive, business-case analysis of the program. Before implementation of the generic sampling program, the physicians in the intervention group and the comparison group had the same GDR of 47.8%. In the first full year of the intervention in 2005, the 301 physicians participating in the generic sampling program had a GDR of 55.3% compared with 54.1% for all of the other approximately 33,000 network physicians. This absolute 1.2 percentage point difference narrowed to 0.8 points in 2006 (59.9% vs. 59.1%). After subtraction of payments made to the vendor of the generic samples, including all administrative costs, the direct drug cost savings were estimated to be $397,486 in 2005 and $453,545 in 2006. The direct drug cost savings per physician participating in the generic sampling program were estimated at $1,321 in 2005 and $719 in 2006. Members paid no copayment for the generic samples and paid lower copayments throughout the continued use of the generic drugs for chronic conditions such as hypertension. Physician practices that participated in the generic sampling program demonstrated an increase in the average GDR that was slightly greater than the increase in the comparison group of all other network physicians in each of the 2 measurement years, 2005 and 2006. Direct drug cost savings after subtraction of all administrative costs associated with the generic sampling program were estimated at $1,321 per participating physician in 2005 and $719 per participating physician in 2006. Members benefited from no copayment for the generic drug samples and from lower copayments for continued use of the generic drugs.