Survey Says: 70 Percent of Physicians Concerned about Prescription Drug Safety

PharmaManufacturing.com
05/18/2006

Recent concerns surrounding the safety of some newer prescription drugs are eroding physicians' confidence in the safety of the medications they prescribe, and consumers' confidence in the medications they take, according to a national survey released May 18. Confidence concerns have resulted in declines in the use of a number of the prescription medications that were singled out in recent Food and Drug Administration (FDA) reviews of drug safety issues, according to new data from Medco Health Solutions, Inc.

"Physicians have always understood that it's critical to consider the risk/reward profile of any medication. However, the implications of the research are clear; for mainstream treatment, the incremental benefit of some new-to-market medicines may not trump the proven safety profile of previous-generation treatments — particularly with the wave of new generic medicines coming to market," said Dr. Robert Epstein, Medco's Chief Medical Officer. "On average most of these drugs have been on the market at least seven to 10 years before they lose their patent exclusivity."

Seven out of 10 physicians (70 percent) surveyed said they were more concerned about the safety of the drugs they prescribe due to recent issues affecting several prescription drugs on the market; and 27 percent indicated they were significantly more concerned, according to The Medco Monitor, a national commissioned survey conducted by Forrester Consulting on behalf of Medco. What's more, physicians aren't the only ones concerned about drug safety. More than half of consumers surveyed (55 percent) indicated they were more concerned about the safety of the medications they take, with one in four significantly more so. Pharmacists are also being affected: 62 percent surveyed said they were more concerned about the safety of the drugs they dispense.

The Medco Monitor is a national survey of 3,200 Americans, including consumers, physicians and pharmacists, designed to provide insights into issues surrounding prescription drug safety and costs. The findings were unveiled at Medco's 2006 Drug Trend Symposium.

"What we've uncovered here is an understandably heightened concern by physicians for the safety of some of the medications they have been prescribing to treat common afflictions — medicines that have increasingly been subjected to recalls, black-box warnings and have been the subject of well-publicized FDA hearings," said Dr. Epstein. "Continuing to provide physicians, pharmacists and patients with the latest information about the medicines they are prescribing and taking remains of paramount importance."

Use of COX-2s and Antidepressants Show Major Declines

Not only do doctors and patients say they're concerned, but further Medco data shows that these concerns have resulted in declines in the use of a number of the prescription drugs at the center of these safety issues. In particular, the cardiovascular risks associated with COX-2 inhibitors and the risk of suicidal tendencies in children using antidepressants have led to a significant drop in their usage.

According to Medco's 2006 Drug Trend Report data, utilization of COX-2 inhibitors decreased 65 percent from 2004 to 2005, due to the market withdrawals of Vioxx in September of 2004 and Bextra in 2005, but also reflecting a significant reduction in the use of Celebrex, the only remaining COX-2 on the market but now burdened with a "black box warning" on its label, the most severe warning issued by the FDA.

Studies showing an increased risk in suicidal tendencies among children taking certain antidepressants, and the FDA's decision to require those medications to carry a black box warning, have significantly impacted their use. A Medco analysis of the prescription claims of 2.5 million patients shows nearly a 13 percent decrease in the number of children ages 19 and under taking antidepressants from 2004 to 2005.

Respondents: "Older drugs are safer"

The fact that many of these recent safety issues involve newer medications has not been lost on physicians and patients. The Medco Monitor survey found that although physicians, pharmacists and consumers all have concerns over the safety of prescription drugs, a sizable proportion feel that medications on the market 10 years or more are safer than newer drugs, and would act accordingly:

• One in three physicians (33 percent) feel that new or recently approved prescription drugs are less safe than drugs that have been on the market for 10 years or more. One in four consumers (29 percent) and one in four pharmacists (26 percent) share that view.



• If costs were equal and provided a choice, 68 percent of physicians would prefer prescribing a drug that has been on the market for 10 years or more; more than half of pharmacists would prefer to dispense an older-generation drug to their patients, and 57 percent of consumers would prefer to take an older-generation drug.

"While drug safety has long been a concern for healthcare providers, we're now seeing a direct link between perceived safety and medication preference," said Brad Holmes in a commissioned survey conducted by Forrester Consulting on behalf of Medco. "Despite the fact that all prescription medications undergo years of intense testing before ever hitting the market, it is clear that physicians, and now their patients, are more comfortable with well-established drugs."

Further findings from The Medco Monitor:

Knowledge Gap in Confidence and Safety of Generic Drugs

The survey found that physicians trail consumers and pharmacists regarding their knowledge of and confidence in the safety and effectiveness of generic drugs which could have broad implications for the forthcoming boon in savings from the expected drug patent expirations of branded drugs worth over $40 billion in U.S. sales:

• One quarter of the physicians surveyed stated that they do not believe generic medications to be chemically identical to their branded counterparts; more than 8 percent said they were unsure. This despite FDA rules that require generic versions of the drug be bioequivalent to the brand medication.



• Nearly one in five physicians believes generic drugs are less safe than brand-name medications, and more than one in four doctors (27 percent) believe generic medications will cause more side effects than brands.

"With such overwhelming clinical evidence over a long period of time validating the therapeutic benefits of generic medicines, these survey results underscore the need to redouble our educational outreach efforts to physicians concerning generics," said Epstein. "Generics deliver the dual benefit of quality therapy that provides economic benefits to the patient and payor, ensuring prescription healthcare remains affordable and accessible."

Prescription Drug Behaviors

Doctors and pharmacists believe that many of their patients regularly engage in questionable behaviors when it comes to using prescription drugs:

• 85 percent of pharmacists and 78 percent of physicians say the average patient has stopped drug treatment.



• 85 percent of pharmacists and 71 percent of physicians say their patients refilled a prescription late.



• 59 percent of pharmacists and 39 percent of physicians say the average patient takes a higher dosage than prescribed.

Physician Outreach

In an effort to assist physicians in making the best possible prescribing decisions and inform them of the latest news in prescription medications, Medco communicates on an ongoing basis through patent expiration alerts, product withdrawal faxes and letters, as well as patient safety alerts using RationalMed, its integrated data system that reviews medical, pharmacy, and laboratory records and identifies potential safety problems.

Methodology

The Medco Monitor research was conducted in the first-quarter of 2006 by Forrester Research, an independent technology and market research company that provides pragmatic and forward-thinking advice about technology's impact on business and consumers. The data collection was done telephonically and captures the perception and attitudes of 3,200 Americans including 2,000, consumers, 300 practicing physicians, 450 retail pharmacists and 450 health benefit administrators.

About Medco

Medco Health Solutions, Inc. manages prescription drug benefit programs that are designed to drive down the cost of pharmacy health care for private and public employers, health plans, labor unions and government agencies of all sizes, and for individuals served by the Medicare Part D Prescription Drug Program. The company is the highest-ranked pharmacy benefit manager on the 2006 Fortune 500 list, reporting revenues of nearly $38 billion in 2005. For more information, visit www.medco.com.