California’s doctors led the nation in prescribing name-brand drugs, with a small chunk of those costs coming from physicians in Los Angeles County who chose the pricier brands over cheaper generic versions, according to 2011 federal data.
Almost 65 million Medicare Part D claims totalling $ 7.5 billion were filed by internal medicine, family medicine and general practice physicians from the Golden State for their patients. And almost 22 percent of those claims were for name-brand drugs such as Crestor, according to federal data collected by ProPublica, an independent, nonprofit news organization.
Analysts from the organization gathered names of physicians, the number of claims they made and the drugs they prescribed and found that four physicians, two from Glendale and two in downtown Los Angeles, were the highest prescribers of certain name-brand drugs in the nation. Together, those four physicians filed 252,924 Medicare Part D claims and prescribed a total of nearly $ 25 million in drugs, including some generic brands.
While the costs seems high and suggest both patients and taxpayers are losing financially, some caution that the figures should be interpreted carefully, since physicians are within their rights to prescribe what they feel are the best medications for their patients. Experts who study health care policies agreed.
“While the cases documented are concerning, overall abuse in Part D is small compared to Medicare fraud more generally,” said Geoffrey Joyce, associate professor and part of the senior research faculty at the Lenoard D. Schaeffer Center for Health Policy and Economics at USC. “Some often extoll how low administrative costs are in Medicare, but those measures ignore fraud, which can be quite significant. Commercial plans have much lower rates of fraud and abuse because of the financial incentives to police it.”
Medicare Part D, a federal program that subsidizes the costs of prescription drugs, launched in 2006 and is largely viewed as a success, Joyce said.
“Within Part D (non-Medicaid), plans are administered and run by private plans,” which means those plans have the incentive in most cases to promote generic use through differential cost-sharing, such as charging a $ 5 to $ 10 co-pay for generics and $ 30 to $ 50 for brands, Joyce said.
“Because of this, generic prescribing in Part D is over 75 percent,” Joyce said.
But the question remains: Why would a physician prescribe name-brand drugs instead of available generic ones unless he or she is influenced by Big Pharma?
In the ProPublica analysis, Dr. Hew Wah Quon, who operates a clinic in L.A’s Chinatown, wrote $ 10 million in prescriptions in 2011, the highest in the nation. From 2010 to 2012, he collected a total of $ 6,432 from Big Pharma companies for one speaking engagement and less than a dozen meals. Compared with thousands of physicians who earn tens of thousands of dollars for speaking engagements, Quon’s influence from companies such as AstraZenica and Pfizer appears insignificant.
Quon did not return calls to the Daily News.
Dr. Tsovinar Tekkelian, a physician in Glendale, billed Medicare $ 4.1 million in 2011. Tekkelian is among the top 10 in the nation to prescribe Diovan, a high blood pressure medication. Two years ago, there was no generic version for Diovan.
Another physician, Dr. Armine Nazaryan, a physician in Glendale, also was among the top 10 in the nation to prescribe Diovan and Crestor.
Neither physician had earned any exorbitant fees from pharmaceutical companies nor would they return telephone calls to answer why they preferred those drugs.
Why Nazaryan and Tekkelian prescribe brand names is unknown, but while their patients pay more out of pocket, the practice is not outside their rights, said Dr. Samuel Fink, an internist from Tarzana and the immediate past president of the Los Angeles County Medical Association.
And those who do stick to brand names are few and far between, he added.
He said some doctors can simply become comfortable with a drug’s profile, its side effects and success, he said.
“I don’t know anybody who preferentially prescribes brand name,” Fink said. “I rarely see when the patient doesn’t tolerate generic. A physician should have a darn good reason for not using generic.”
For a doctor that is in the daily practice of medicine, that doctor is often in the moment and does not think of him or herself as an agent of cost-saving or a public health person, added Dr. Pedram Salimpour, a board member of the Los Angeles County Medical Association and the president-elect.
“It’s a dilemma: Are you that patient’s doctor or are you a cost-saver for America?” Salimpour said. “Hopefully you can do both, but life is complicated.”
Salimpour said when the public is being bombarded daily with direct-to-consumer advertising, sometimes patients want what they see on TV.
“The most important thing for that doctor in that moment is patient compliance,” Salimpour said. “When compliance is the most important thing to you, and the patient is being bombarded with advertising and direct-to-consumer advertising, and there’s a brand name, you’re more likely to get the patient to do what they want.”
The issue of what patients want versus what physicians prescribe can sometimes leave pharmacists in the middle, said Jon Roth, CEO of the California Pharmacists Association. The pharmacist is always the first to understand the generic market.
“We would love to see greater collaboration between pharmacists and physicians,” Roth said. “Pharmacists are always looking at the balance between the maximum therapeutic impact that patient is coming in for and contrasting that with the other sensitivities, such as the cost of health care overall.”
Joyce, of USC, said there is likely some level of abuse given the size of the Medicare Part D program and the number of physicians prescribing under Medicare. But he said there are solutions, including imposing mandatory generic substitution rules.
“That would eliminate a lot of brand overuse, particularly in Medicaid,” Joyce said.
He also said the Centers for Medicare & Medicaid Services should monitor use within the program to identify problem providers.
There are no plans from the federal government to impose such standards, according to a spokesman from CMS.
“Part D formularies encourage beneficiaries to choose generic medication over a brand option when available,” a spokesman told the Daily News. “By law, Medicare must cover items and services that are reasonable and necessary. Within those rules, doctors and their patients are free to make medical treatment decisions that are best for the patient.” ___
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