Doctors Miss Chance to Recommend Equally Effective Generic Stomach Meds

Primary care doctors often prescribe over-the-counter medicines for acid reflux and chronic constipation, but, in doing so, they're missing the opportunity to save patients money.

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Researchers at the University of Michigan Health System surveyed U.S. primary care doctors about their suggested uses of OTC medications for heartburn and chronic constipation.

"Despite feeling that name-brand and store-brand laxatives are equally effective, the majority of primary care doctors surveyed continued to recommend name-brand laxatives and underestimate the cost savings associated with buying store brands," says gastroenterologist William D. Chey, M.D., professor of internal medicine at the U-M Health System and lead author of the survey.

A similar prescribing trend was found in primary care doctors' belief about the use of OTC medicines for gastroesophageal reflux disease (GERD). A large and growing group of Americans have heartburn and other symptoms of GERD at least weekly.

In the survey, three-fourths of doctors said store brands and name-brand proton pump inhibitors had equal bioequivalence, meaning they had the same active ingredients and ability to suppress the production of stomach acid. The Food and Drug Administration requires generic drugs have the same high quality, strength, purity and stability as brand-name drugs.

Only 25 percent regularly advised GERD patients to use a store brand, and more than one-third never made this recommendation. But 86 percent of primary care doctors believed that store brands were cheaper, though they tended to underestimate the potential savings.

The survey results, which included more than 337 primary care doctors nationwide, were presented during the 2016 Digestive Disease Week annual meeting in May.

The typical approach to treatment

Primary care doctors treat the vast majority of patients with GERD and chronic constipation.

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"At a time when cost and coverage of prescription medications for so-called lifestyle conditions forces patients to over-the-counter treatments, it is important to evaluate how PCPs perceive and utilize store-brand and brand-name products," says Chey.

Chronic constipation is a painful and frustrating problem for 20 percent of the U.S. population. For a typical patient, 98 percent of primary care doctors surveyed recommended OTC treatments including fiber supplements, osmotics and stool softeners.

When confronted with a patient who did not improve with first-line therapy, 88 percent of primary care doctors still recommended an OTC treatment as a second option. Few doctors surveyed would write a prescription as a second-line therapy.

Although the majority of primary care doctors believed store-brand medications had equal clinical effectiveness and reduced cost for GERD and chronic constipation patients, few reported discussing these points with their patients.

When recommending an OTC medicine, brand names seen in ads and commercials may be easier to remember than advising to read a label for active ingredients such as polyethylene glycol, for example.

"[But that's] a behavior that can cost their patients 30 percent more for exactly the same medicine," Chey says. "Systematic efforts are needed to ensure patients are better educated about cost-effective treatment options for GERD and chronic constipation."

The survey was supported by an unrestricted grant from Perrigo, the world's largest manufacturer of OTC pharmaceutical products for the store-brand market.