Niteesh K. Choudhry, MD, PhD; Thomas D. Denberg, MD, PhD; Amir Qaseem, MD, PhD, MHA,; for the Clinical Guidelines Committee of the American College of Physicians
Note: Best practice advice papers are “guides” only and may not apply to all patients and all clinical situations. Thus, they are not intended to override clinicians' judgment. All ACP best practice advice papers are considered automatically withdrawn or invalid 5 years after publication or once an update has been issued.
Disclaimer: The authors of this article are responsible for its contents, including any clinical or treatment recommendations.
Acknowledgment: The members of the ACP Clinical Guidelines Committee thank Drs. William Shrank, Joshua Gagne, and Troyen Brennan for providing expert recommendations on the key articles that were the basis for the literature review. They also thank Dr. Shrank for extensive input on an earlier version of this article and Danielle Isaman and Alexis Krumme for exceptionally helpful assistance with background research and manuscript preparation.
Financial Support: Financial support for the development of this paper comes from the ACP operating budget.
Disclosures: Dr. Choudhry reports grants from CVS Caremark; Sanofi; AstraZeneca; Merck; PhRMA Foundation; and the National Heart, Lung, and Blood Institute outside the submitted work. Dr. Shekelle reports personal fees from ECRI Institute outside the submitted work and a patent with royalties paid to UpToDate. Dr. Barry reports grants, personal fees, and nonfinancial support from the Informed Medical Decisions Foundation/Healthwise and personal fees and nonfinancial support from Massachusetts General Hospital/Harvard Medical School outside the submitted work. Dr. Dallas reports stock holdings in Ortho Pharmaceutical, Sanofi, Merck, Pfizer, and GlaxoSmithKline. Dr. Schünemann reports that he played a critical role in the World Health Organization cervical cancer screening and treatment guidelines for low- and middle-income countries. Authors not named here have disclosed no conflicts of interest. Authors followed the policy regarding conflicts of interest described at www.annals.org/article.aspx?articleid=745942. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?ms Num=M14-2427. A record of conflicts of interest is kept for each Clinical Guidelines Committee meeting and conference call and can be viewed at www.acponline.org/clinical_information/guidelines/guidelines/conflicts_cgc.htm.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that she has no financial relationships or interests to disclose. Darren B. Taichman, MD, PhD, Executive Deputy Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer.
Requests for Single Reprints: Amir Qaseem, MD, PhD, MHA, American College of Physicians, 190 N. Independence Mall West, Philadelphia, PA 19106; e-mail, firstname.lastname@example.org.
Current Author Addresses: Dr. Choudhry: Division of Pharmacoepidemiology, Brigham and Women's Hospital, Harvard Medical School, 1620 Tremont Street, Suite 3030, Boston, MA 02120.
Dr. Denberg: Carilion Clinic, PO Box 13727, Roanoke, VA 24014.
Dr. Qaseem: American College of Physicians, 190 N. Independence Mall West, Philadelphia, PA 19106.
Author Contributions: Conception and design: N.K. Choudhry, A. Qaseem.
Analysis and interpretation of the data: N.K. Choudhry, A. Qaseem.
Drafting of the article: N.K. Choudhry, T.D. Denberg, A. Qaseem.
Critical revision of the article for important intellectual content: N.K. Choudhry, T.D. Denberg, A. Qaseem.
Final approval of the article: N.K. Choudhry, T.D. Denberg, A. Qaseem.
Obtaining of funding: A. Qaseem.
Administrative, technical, or logistic support: N.K. Choudhry, A. Qaseem.
Collection and assembly of data: N.K. Choudhry, A. Qaseem.
Choudhry NK, Denberg TD, Qaseem A, for the Clinical Guidelines Committee of the American College of Physicians. Improving Adherence to Therapy and Clinical Outcomes While Containing Costs: Opportunities From the Greater Use of Generic Medications: Best Practice Advice From the Clinical Guidelines Committee of the American College of Physicians. Ann Intern Med. 2016;164:41-49. doi: 10.7326/M14-2427
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Published: Ann Intern Med. 2016;164(1):41-49.
Published at www.annals.org on 24 November 2015
The discrepancy between health care spending and achieved outcomes in the United States has fueled efforts to identify and address situations where unnecessarily expensive therapies are used when less costly, equally effective options are available. The underuse of generic medications is an important example.
A literature review was conducted to answer 5 questions about generic medications: 1) How commonly are brand-name medications used when a generic version is available? 2) How does the use of generic medications influence adherence? 3) What is the evidence that brand-name and generic medications have similar clinical effects? 4) What are the barriers to increasing the use of generic medications? 5) What strategies can be used to promote cost savings through greater generic medication use? This article was reviewed and approved by the American College of Physicians Clinical Guidelines Committee.
Clinicians should prescribe generic medications, if possible, rather than more expensive brand-name medications.
Appendix Table. Key Articles Used to Perform the Literature Searches
American College of Physicians best practice advice: improving adherence to therapy and clinical outcomes while containing costs: opportunities from the greater use of generic medications.
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