Counter-marketing and Generic Drugs: The Medical Student Prescription

Context: Prescription drugs are often prohibitively expensive for patients in the US, especially underserved populations. Some studies suggest that physicians might have insufficient unbiased information on the quality, effectiveness and cost advantage of generic compared with proprietary drugs or their therapeutic equivalents. Many physicians also do not have a detailed understanding of how price can create barriers to access for patients. Educating physicians early in their career and changing prescribing patterns to include more generics and therapeutic equivalents could make essential medicines more accessible for many in the US. This process could also lead to more efficient use of scarce health care dollars.

Purpose: Researchers assessed the value of medical students as a target audience for educational programs on generic drugs. Additionally, the most effective channels of communication for counter-marketing were identified. Physicians, pharmacists and consumers were also assessed as potential target audiences.

Methods: Facilitators explored the knowledge, attitudes and perceptions of first- and second-year medical students using a focus group format. The discussion centered on sensitivity to cost of care and awareness of bioequivalence of generic and brand name drugs. Suggestions on potential programs to modify physician prescribing patterns were collected.

Findings: The academic setting provides a unique opportunity to influence the prescribing patterns of future physicians. Focus group participants were enthusiastic about the topic and motivated to learn more; they expressed a desire for better access to unbiased information. Students provided facilitators with concrete suggestions for additions to medical school curriculum, including the following:

- Integrating PDA programs such as Epocrates Rx

- “Red flag” drug lists indicating common expensive drugs with generic alternatives

- Discussions on the regulatory issues related to generic drug approval, including information on bioequivalence and non-inferiority for generic substitutions

- Debates and informational seminars featuring guest speakers from the Food and Drug Administration, academia, private practice, industry and health care researchers.

Recommendations: Further research is necessary to establish external validity of the findings and determine ways to integrate the proposed educational programs into medical school curricula.