A link between socioeconomic status and the prescription of brand-name drugs in the US, has been revealed by a team of researchers based at Brown University .
The US spends more on prescription medicines than any other industrialized country in the world. The availability of generic and biosimilar drugs has the potential to drive healthcare expenditure down and it has been reported that generics now account for nearly nine out of 10 US prescriptions . However, US saw a 20% increase in spending between 2013−2015 which is due to a number of reasons, such as the escalating prices of both brand-name and generic drugs [3, 4].
This recent study, published in Medicine, notes that generics are relatively underused in the US . To improve generics uptake and reduce the use of brand-name drugs successful interventions are required. As such, the researchers set out to find out if there is a link between socioeconomic and demographic factors and prescription drug patterns among medical specialties that show high brand-name outpatient prescription use. Knowing more about such relationships can inform interventions aiming to increase the usage of generic over brand-name drugs.
The team had access to county level data, the Medicare Part D Public, which gave them information about the percentage of brand-name claims at the county level in 2015. This was used in combination with data from the American Community Survey (ACS) from the U.S. Census Bureau (2012−2016), to determine socioeconomic and demographic variables. The team focused on individual incomes as a measure of socioeconomic status and they also took note of age, gender and race.
Their investigations analysed claims spanning 40 medical specialties, nearly four million brand-name claims and over 14 million generic claims. These drugs were filled throughout the US to nearly 36 million beneficiaries.
Results: counties with more high earners have more brand-name prescriptions
The researchers found that the medical specialities with the highest brand-name outpatient prescription use were Internal Medicine, Family Practice, General Practice, Cardiology and Ophthalmology. These specialities accounted for 71% of the total amount of brand-name drugs filled under Medicare Part D in 2015. In addition, their key finding is that there is an increased likelihood of brand-name drug prescriptions in counties with a higher percentage of individuals earning over US$100,000.
To visualise the US counties with high amounts of brand-name drugs filled, the team carried out a hot-spot analysis. This revealed that many rural areas and counties surrounding big cities, have county clusters where there are high rates of brand-name drug prescribing.
The researchers explain that, Medicare Part D plans are delivered primarily as fee-for-service or as Medicare Advantage. Medicare Advantage is popular among lower income groups as it is associated with lower out-of-pocket costs of managed care. Of relevance to the hot-spot analysis, Medicare Advantage beneficiaries are usually concentrated among a subset of medical providers in inner-city or rural communities, whereas brand-name prescription hot-spots surround cities and are in rural areas. Despite this observation, they note that additional research is needed to evaluate exactly why an increase of high-income individuals in a given county is likely to result in higher brand-name prescription claims.
Conclusion: interventions should consider county-level socioeconomic factors
In their conclusion, the team highlight that socioeconomic status and demographics, particularly patient income, should be considered when attempting to reduce brand-name drug prescriptions. This is particularly relevant in counties with a large proportion of high earners. They note that the results of the study should be referred to when planning interventions to reduce brand-name drug prescriptions. These interventions may benefit from initially focusing on counties with a large proportion of high-income households to best mitigate brand-name drug prescription rates. The researchers also stress that the implementation and delivery of successful interventions that apply the county-level findings of this research have the capability of decreasing patient costs and reducing healthcare expenditures significantly at the national level.
Conflict of interest
The authors of the research paper  declared that there was no conflict of interest.
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1. Connor V, Fadi S, Eleftherios M. The role of county-level socioeconomic status on brand-name prescriptions in Medicare part D. Medicine: 2020;99(9):p e19271.
2. GaBI Online - Generics and Biosimilars Initiative. Cost-effectiveness of generic dabigatran [www.gabionline.net]. Mol, Belgium: Pro Pharma Communications International; [cited 2020 Jul 31]. Available from: www.gabionline.net/Generics/Research/Cost-effectiveness-of-generic-dabigatran
3. GaBI Online - Generics and Biosimilars Initiative. US policy to combat high-priced generics [www.gabionline.net]. Mol, Belgium: Pro Pharma Communications International; [cited 2020 Jul 31]. Available from: www.gabionline.net/Generics/Research/US-policy-to-combat-high-priced-generics
4. GaBI Online - Generics and Biosimilars Initiative. Why does the US face high-priced generics and drug shortages? [www.gabionline.net]. Mol, Belgium: Pro Pharma Communications International; [cited 2020 Jul 31]. Available from: www.gabionline.net/Generics/Research/Why-does-the-US-face-high-priced-generics-and-drug-shortages
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