“Dispense As Written”

“Dispense As Written”

Sometimes patients could notice the next line in their prescription: “dispense as written”. It means pharmacist should fill the prescription with a brand-name drug (which is on the prescription) even if a generic version of the same medication is available. In the case of brand-name medication been prescribed, a customer usually pays much more for the medication. According to American Journal of Medicine, the total cost of brand-name prescription medications is about $7.7 billion.

Generics are the cheaper alternative, which has saved American healthcare system about $824 billion over the last ten years, according to IMS Health (IMS Health is a market researching company). Even more, costs were saved by patients who had to pay for their medications out of pocket. Those savings were able with help of pharmacists, who filled prescriptions with generics when it was possible.

The Food and Drug Administration said that generics consisted of same active substances as their brand-name alternative. Also, they have the same dosage, strength, route of administration and safety. The main reason of their lower price is an ability of pharmaceutical companies and compounding pharmacies to prepare a generic version of a brand-name drug after manufacturer lose its’ patent.

According to American Journal of Medicine article, about 5% of $5.6 million prescriptions were designated as “dispense as written” (“DAW” for short) and so patients have paid about $1.7 million more than they could pay if generics were prescribed (one-month period).

It is easy to see that a price difference is quite impressive. According to the same research, a lot of doctors still do not trust generic medications. Mostly older doctors and their colleagues are suspicious of generic medications and more of doctors have some concerns about a quality of generic drugs.

The other factor of choosing brand-name medications, instead of cheaper alternatives, is advertising effect. Patients and doctors remember brand-name drugs mentioned in social media, TV or radio. After doctor prescribes a brand-name medication, it could be also a habit to prescribe medications of a same brand-name medications manufacturer.

On the top of that, because of drug samples and some merchandise left by a pharmaceutical company representative (pens, cups and other small gifts) brand-names are far more easily to remember.  For example, cholesterol medication called atorvastatin has a brand-name alternative called Lipitor.

There could be a reason for doctors not to trust to generics. Maybe, generics were low-quality medications in past, but now they are on the same level with brand-name drugs, according to American Medical Association Journal. They spend 25 years to check if there is any difference between generic and brand-name medications used to treat heart issues and high blood pressure.

Possible reason for lower trust to generics

Take the category of drugs designed to treat cardiovascular disease. A 2008 review in the Journal of the American Medical Association looked at nearly 25 years of research on how several commonly used brand-name blood-pressure and heart drugs matched up against their generic versions. The study’s authors concluded that “evidence does not support the notion that brand-name drugs used in cardiovascular disease” are any better than the cheaper alternatives.

The Same conclusion was after comparison of blood thinner medications and anti-seizure medications. However, anti-seizure medications met a resistance from American Academy of Neurology (AAN). AAN stated that generic versions of anticonvulsant medications should be obtained only after physician’s approval.

There are some exceptions, however. For example, some hormone medications like Synthroid, which is used to treat thyroid disease and available in generic form (levothyroxine). The FDA knows about generic medications potential issues, caused by different amount of active ingredient or its’ absorption/distribution. Because of those reports, FDA develops specifications about drug potency the generic form of medication must achieve to be released on the market.

However, generics are not always the best choice. You can read about the cases when brand-name drugs are better than generics, despite their price. 

In some states, pharmacists are required to offer generic forms of medications if it is available and unless a health care specialist will specify a prescription to be filled as written. Meanwhile, in the other states have DAW limits to control the amount of “dispense as written” prescriptions.

The number of prescribed brand-name medications decreased in Massachusetts when physicians were required not to only designate DAW, but also to explain why it cannot be replaced with a generic alternative. This requirement led to decreasing of Medicaid expenses by $150 million during 2009 (data from Generic Pharmaceutical Association)

It is interesting, that there is not only direct saving money aspect can be found in generic medications usage. Studies showed that patients, who take generics are stricter to their regimen and do not skip their doses. It leads to more effective treatment and decreases other expenses down the road.

Patients, which were prescribed brand-name drugs, are more likely to skip doses or take a half of the dose just to make their medication to last longer. In some cases, because of the price of brand-name drugs, people are leaving their pharmacy with empty hands.

You can read more about pharmacists and medical adherence increase in this article.

It is a big issue for health care system when a patient has to pay a higher price for the medications aside from other medical expenses. It also leads to higher hospital outcomes.

Dmytro Nikolayev

Dmytro Nikolayev spent many years working in the field of healthcare, especially in its technical part. Gained much experience in Open Data and Machine Readable Formats used in the industry. Also, built several IT projects that were designed to help people with their healthcare decisions. Now he is an editor and author of Pharmacy Near Me

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