Robot rep latest tactic in generics push

Francis X. Solano, MD, an internist at a University of Pittsburgh medical clinic, writes many more prescriptions for generics than he did even a short time ago. That's the way Highmark BlueCross BlueShield, the largest health insurer in Pennsylvania, planned it.

Late in 2003, the company paid for two robot-like vending machines to be hauled into Dr. Solano's practice. Each machine resembles a large filing cabinet fused to a computer printer and a bank machine. They contain samples of about 20 generic medications apiece, including antibiotics, antidepressants and antihypertensives.

Dr. Solano has come to use the automated apothecaries several times a day. He enters a pass code and selects a drug name on a touch-sensitive screen. One of eight drawers pops open. He removes a 30-day, prepackaged sample, verifies its contents with a bar-code scanner, and hands the patient a sheet of drug information that is generated automatically.

"It's an incredible way to get people started on drugs that are generic, and it's also a value-added service for the patients," Dr. Solano said. "If it takes 30 seconds to a minute it's a lot, and you have a happy patient."

The robot drug dispenser is but one of the more recent and overt tools managed care plans are using to get physicians to influence their patients to fill their prescriptions with generic drugs, thus reducing pharmaceutical costs, which plans generally report as their fastest-growing expense.

The generic drug robots, marketed for two years by San Diego-based MedVantx, are present in about 45 medical offices in Pennsylvania, California, New Jersey and Oregon, said Rob Feeney, the company's president and CEO. The firm has contracts with more than 20 health plans, including Indianapolis-based WellPoint, the nation's largest health insurer, which is paying MedVantx to maintain the systems at 15 sites in California.

The machines, which are continually restocked with free medication samples at no cost to doctors, are yielding encouraging results, Feeney said. The generic prescribing rate of physicians who have the machines has risen by about 3% to 5% overall, he said, and in certain drug classes, the increase has been closer to 12%.

Insurers say numerous other tactics for involving doctors in the quest to boost generics are under way or being considered. For example, plans and affiliated pharmacy benefit management companies are dispatching so-called "counter-detailers" -- employees who drive from practice to practice to discuss generic drugs with any doctors who will listen. The term "counter-detailers" comes, of course, from their role of competing against name-brand pharmaceutical detailers who regularly stop by doctors' offices.

"In the beginning, physicians had a particular fondness for brand-name drugs," said Richard Douglass, a pharmacist who makes the rounds of medical practices in the Cleveland area for Medco Health Solutions, a leading PBM. "Many more physicians now have come around to the idea that we only have so many health care dollars to go around."

Edward L. Langston, MD, RPh, a family physician in Lafayette, Ind., and a member of the AMA Board of Trustees, said he had no quarrel with such attempts to encourage physicians to embrace generics, so long as it doesn't feel like coercion.

"There are a number of generic medications that make a lot of sense," said Dr. Langston, an assistant professor of pharmacy at Purdue University. "If I can use an FDA-approved generic that's appropriate for my patient, that's my first choice."

Additional strategies by insurers to promote generics include:

• Web sites that allow physicians or plan members to calculate the cost of a brand-name prescription versus its generic equivalent.
• Targeted mailings that urge patients to talk with physicians about how they can save money by switching to specific generics.
• Continuing education programs, sponsored by insurers, that inform physicians about new generics.
• Waiving of co-payments for generic drugs, sometimes by using coupons that doctors can give out.
• "Pay-for-performance" initiatives that reward doctors writing more generic prescriptions. BlueCross BlueShield of Michigan this year revamped and greatly expanded an incentive pay program that tracks, among other things, how doctors score on generic dispensing rate and average ingredient cost. Ten large medical groups with 3,000 doctors participate, compared with six groups with 1,200 doctors five years ago.

AMA policy states that physicians may participate in pay-for-performance plans but that they must make clinical decisions that are best for the patient, not for the plan.

Giving an incentive

Dr. Solano, the Pittsburgh internist, is participating in two pay-for-performance programs, including one sponsored by Highmark. Both incorporate measures of how many generics he prescribes. He said, though, that some doctors are dubious about competing for bonuses based on their generic prescribing rates, believing it's largely motivated by insurers' financial self-interest.

That's not to say Dr. Solano hasn't become rather attached to the generic drug robots by now. He says they're "wonderful" and "slick" -- even if they do take up a lot of space and have to stay out in the hallway.

The robots are churning out 2,000 samples a year for his patients at last count, and, according to MedVantx, the machines are saving patients $137 per year, on average. So he thinks he's doing his share to battle the rising cost of medical care, and he feels every day like he's in drug sample heaven.

"I never had this scope of things in my closet," he said. "Now I never run out of samples."