Medication Prescribing

Vineet Arora, MD, on Health Care Clinicians’ Attitudes Toward Generic Medications

The results of a recent study1 show that physicians and nurse practitioners have a low willingness to discuss or prescribe generic medications due to providers’ general skepticism.

This finding comes as a result of a cross-sectional study that included 369 physicians registered with the American College of Physicians and 493 nurse practitioners registered with the American Association of Nurse Practitioners. The results indicated that 16% (n = 138) of the total participants were considered generic skeptics. In addition to lower willingness to discuss or prescribe generic medications, study participants were more reluctant to prescribe generics to patients with a brand preference, than those who were brand neutral.

Study author Vineet Arora, MD, who is a professor of medicine at the University of Chicago, answered our questions about her team’s study.

Consultant360: Your study focused on the attitudes of physicians and nurse practitioners on prescribing generic versions of both oral contraceptive pills and antidepressants. What knowledge gaps were you hoping to fill with your analysis?

Vineet Arora: We did an earlier study2 of focus groups showing knowledge gaps regarding the generic drug process, which led us to believe this was important. 

C360: What is the current standard of care for prescribing brand name vs generic medications?

VA: This depends on your state. Some states do generic substitution automatically, which is very different if you don't. We did control for this and did not see that state policy impacted health care practitioners’ prescribing practices. The practitioners’ beliefs did influence their prescribing practice though, which is why education is important.

C360: The results indicated that there was a low willingness to discuss or prescribe generic medications due to providers’ general skepticism. Did any physician or nurse practitioner characteristics play a role in these results?

VA: We did see that some characteristics were associated with generic skepticism. For example, nurse practitioners were more skeptical than physicians, and everyone was more skeptical about generic oral contraceptive pills than antidepressants. Infrequent prescribers were much less likely to be willing to discuss or prescribe generic medications. This highlighted the importance of education and awareness for infrequent prescribers.   

C360: What factors might improve providers’ general skepticism about generic medications?

VA: In 2 follow-up studies2,3, we actually showed that training does help improve providers’ general skepticism. In these 2 studies, we examined both primary care physicians and nurse practitioners.

C360: What is the next step in your research on generic vs brand name prescription medications?

VA: We believe in the importance of default settings to help promote better prescribing. System solutions will likely yield the best outcomes. Patient empowerment is important too.

 

References:

  1. Thaver A, Chee M, Wroblewski K, et al. Physician and nurse practitioner attitudes on generic prescribing of oral contraceptive pills and antidepressants. J Gen Intern Med. 2020;35:3478-3484. doi:10.1007/s11606-020-06239-6
  2. Chee M, Lenti G, Farnan JM, et al. Development and testing of a module to promote generic oral contraceptive prescribing among nurse practitioners. J Am Assoc Nurse Pract. 2020;32(1):24-34. doi:10.1097/JXX.0000000000000349
  3. Lenti G, Norenberg A, Farnan JM, et al. Development and testing of a web module to IMPROVE generic prescribing or oral contraceptives among primary care physicians. J Clin Pharm Ther. 2019;44(4):579-587. doi:10.1111/jcpt.12853