Payoffs to doctors ? You decide.
Payoffs to doctors ? You decide.
Docs Get Paid To Switch To Generic Drugs
Incentives Raise Ethical Questions
UPDATED: 4:15 pm EDT August 2, 2007
BOSTON -- Health insurers are giving doctors incentives, sometimes in cash, to
switch patients to generic brands, Boston television station WCVB has reported.
Feature: Generics Just As Good?
The payments are legal, but health care experts said they clearly raise ethical
questions if patients are not told the reasons behind the switch.
Much of the controversy centers on the cholesterol drug Lipitor, which is the
best-selling medicine in the world. It is currently under a patent and does not have
a generic version.
Thousands of Massachusetts patients recently discovered their insurer won't pay
for it anymore or that their out-of-pocket cost has skyrocketed. Other patients told
WCVB they were switched by their physicians with little explanation.
Earlier this year, Blue Care Network in Michigan paid 2,400 doctors $2 million to
switch their patients from Lipitor to a generic version of its competitor, Zocor. They
were paid $100 for each patient they switched from Jan. 1 through March 31, 2007.
"Without saying to the patient, 'I have a financial incentive in making this decision,
which goes along with my professional incentives to do what's right for you,' it's
unethical," said professor Regina Herzlinger of Harvard Business School. "It's a
clear conflict of interest."
WCVB asked Blue Care Network of Michigan if patients were told of the financial
kickback.
A spokeswoman said, "Not specifically."
In Massachusetts, financial arrangements for switching patients from Lipitor are
less blatant, but they do exist.
In a letter obtained by WCVB, Partners Community HealthCare's Medical Director
Dr. Thomas Lee told his colleagues that "physicians will increasingly be rewarded
in our pay-for-performance contracts if we increase the percent of generics we
use. Increasing our use of generic statins is therefore very much to our
advantage."
Former Lipitor patient Genie Holland said, "I'm shocked. They're paying the
doctors? Yes. I'm shocked."
Holland said she was surprised earlier this year when her doctor switched her
from Lipitor to a generic version of Zocor without explanation "because it had
worked for me for so long. I also found that my cholesterol went up after I went on
the generic."
But Herzlinger said the medical efficacy is irrelevant to this debate.
"You've got to tell the patient that 'I'm switching you to a generic, not only because
it's best thing for you and it's going to save you money out-of-pocket, but because
I'm going to make more money as a result of that,'" she said.
In Massachusetts, arrangements vary according to the insurance plan. Some
doctors get a cash bonus at the end of the year for various money-saving
practices, including switching their patients to generics.
Another patient whose doctor switched her from Lipitor to a generic version of
Zocor said, "It really is upsetting to think they would get a kickback from using
certain drugs."
That patient has taken several cholesterol medications over 10 years and had the
best results with Lipitor, but she, too, was recently switched to a generic with little
explanation.
Doctors with whom the station spoke, including Dr. Robert Fraser, said they moved
most people off Lipitor because patients save money. He said he gets a kickback
for only some of his patients, depending on their insurer.
"Well, the problem is I don't know which patient I'm seeing at that moment. If you
walk into my office and at that second, I don't know if you're an HMO patient or
not."
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to what I posted on this subject in another thread; but I got to wondering, if you don't mind replying, do you or have you taken statins? Or what experience contributes to your opinion about them? (edit - I don't mean this to sound like an attack; it certainly isn't meant to be one.)
