A recent report published in the Archives of Internal Medicine highlights some “low-hanging fruit” for anyone trying to deliver more cost-effective healthcare. The authors (I am the first author and Harlan Krumholz, CardioExchange editor-in-chief, is the senior author) describe how branded formulations of fenofibrate — marketed by Abbott as Tricor and Trilipix — account for the vast majority of fenofibrate prescriptions, even though generic fenofibrate has been available for almost a decade.
Abbott was able to stay one step ahead of the generic competition by repeatedly changing the dose of its branded formulations: clinicians continued to prescribe branded versions of the drug and pharmacists were powerless to switch these prescriptions for generics due to the differences in dose. We have helped reward Abbott with an astonishingly high market share, even though the company never demonstrated the incremental benefit of its reformulations.
As physicians, we should ask how this happened. Why did we not switch patients over to generic fenofibrate? Were we unaware that generics were available? Did we take for granted that generic substitution would happen at the pharmacy? Did we fail to notice the repeated changes made to the doses of branded fenofibrate?
Unlike most cost-effectiveness calculations, this one should be easy. This is not a complicated decision in which we need to weigh relative efficacy against relative cost: clinicians have a choice between branded fenofibrate and generic versions of the exact same drug — but the generics are half the price.
We should also remember that there is an ongoing debate about the appropriate role of fibrate therapy in lipid management in light of the findings from the FIELD and ACCORD trials, which showed that fenofibrate did not significantly improve cardiovascular outcomes. Regardless of your views on the efficacy of fenofibrate, do your patients and the healthcare system a favor – write the generic.