He contends Medicare Part D causes physicians to prescribe more brand name drugs:
You have a patient who is on Medicare Part D. Suddenly, all of these new and spiffy trade-name medications are only $3.10! So what does the doctor do? He starts writing for that ARB when a generic ACE-I is okay. He starts writing for Lipitor when the patient has been on generic Zocor for months. He starts . . . prescribing Levaquin when generic Cipro would be okay. “Hell! Its only $3.10! Why not! The patient only pays $1 for generics, whats another $2.10 for a drug that works ‘better’!!!”.
I’ll have to dispute that. I don’t think I’ve ever gone generic to brand-name because of Medicare Part D. Regarding the fluoroquinolone comment, there are cases where broader spectrum antibiotics like Levaquin and Avelox are better clinical choices than Cipro.
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{ 5 comments }
This pharmacist obviously has an inferiority complex. If he wants to script meds, he should go to med school. Otherwise, tell him to shut up and get back to dispensing meds for patients and let doctors do the real work.
You make good points RJS, but I deleted the comment due to foul language.
Thanks,
Kevin
I think that for most internists or FPs, Medicare part D coverage has little or no impact on prescribing patterns. I’d never use cipro, for example, to treat community-acquired pneumonia, where levaquin or avelox are good choices in, e.g., diabetics.
However for a young woman with an uncomplicated UTI cipro or bactrim are both excellent choices.
little to do with cost or coverage in these scenarios.
There are important differences between drugs even in the same class. This is especially true with antibiotics. Other examples would be beta-blockers and other anti-hypertensive classes. I remember once i got letters from a pharmacy benefits company saying that an ARB wasn’t covered for my diabetic patient – they were recommending changing to norvasc (???)
Apologies for my language, Kevin.
You’ll have to excuse me… it’s been a very long week with little sleep capped off by my getting into an unavoidable car accident on the way home from work during this storm.
I will respond to this post in a blog entry of my own shortly.
wow, in response to your “anonymous” comment. I spent 5 years studying every aspect of drugs. I went to a pharmacy school next to a med school. I met some of the med students and they take 1 semester of pharmacology. I believe pharmacists are trained to know all aspects of drugs. Therefore, give us the respect we deserve and let us do our jobs. Oh and p.s. we do really work schmuck.
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