Brand Name or Generic?
How to Choose a Drug for the Rest of Your Life
By John Santa, MDDecision-makers at the Portland Veterans Affairs (VA) Medical Center, where I have a medical practice, have very savvy buying skills, especially when it comes to prescription drugs. They understand the product they are buying and the purpose it will be used for, compare similar products, and follow the money. As a result, the VA gets great buys on drugs and uses the savings for other important health care needs.
Drugs that lower cholesterol, especially the statin drugs, provide a good example of how this works.
Statins don’t cure a disease like antibiotics do. Rather, they are prescribed to treat a number—your cholesterol level. Lowering your cholesterol doesn’t mean you won’t have a problem. It just reduces the likelihood.
I know when I start a patient on a statin I am committing that individual to years of exposure to side effects and thousands of dollars of expense. There are several statins. The VA has made my selection easier by narrowing the choices to two. That decision fits with the scientific evidence that all the statins lower cholesterol and that some are more potent than others. I know that some are more expensive than others. Both statins chosen by the VA not only lower cholesterol but also reduce heart attacks and death.
The VA asks that I start treatment with a generic statin, lovastatin. While it is not always as potent as other statins, lovastatin usually works well, often at low doses and lowers cholesterol successfully for most patients. I know that my patients can get it at less cost almost anywhere, probably for many years to come—an important factor since many veterans receive care outside of the VA at some time. Lovastatin has side effects but no more so than other statins. I also know that using a generic is a smart purchasing decision because it allows the VA to negotiate lower prices for all the statins.
In some cases, I can use a second more potent statin—simvastatin. While it is a more expensive brand version now, it will soon be available as a generic, making it more affordable for the many years my patients will be on it.
In the two years I have practiced at the VA the two statins purchased by the VA have worked for my patients. These medicines are part of good care for veterans and part of a smart purchasing process that saves resources for veterans and taxpayers.
John Santa MD, MPH practices internal medicine part time at the Portland VA Medical Center.He is also the medical director for the Drug Effectiveness Review Project (DERP) at Oregon Health and Science University. DERP provides systematic evidence-based reports comparing drugs in many of the most prescribed classes. Summaries of the reports are available on AARP’s website at www.aarp.org. Search on "effectiveness research."
