Taste Testing Generic Drugs
by Jason S. Brinkley, PhD, MA, MS
On the Brink addresses topics related to data, analytics, and visualizations on personal health and public health research. This column explores current practices in the health arena and how both the data and mathematical sciences have an impact. (The opinions and views represented here are the author’s own and do not reflect any group for which the author has an association.)
When I was a kid, I was fascinated by the Pepsi Challenge. There were all these commercials where people were blindfolded and asked to take a sip of two cups and identify which was “better” between Coke and Pepsi. I remember watching those commercials and thinking that the adults in them must be the dumbest ones around; I was a child and I could taste the difference in a single sip. I remember bragging to a friend during an overnight sleepover and forcing him to help me set it up so I could show him how good I was at the game. But after I put on the blindfold, my friend did something unexpected; he gave me Pepsi and a different cola (a generic store brand) and I was stumped using just one sip. I remember getting angry but also learning a valuable lesson about expectations. Coke was not designed to taste like Pepsi, but what happens when you put Pepsi against a store brand that was designed to taste like the more popular brand?
Recent spending on pharmaceuticals in the US has fallen somewhere between 350-500 billion dollars per year. By comparison, recent total US food at home spending totaled about 600 billion dollars. While that is a lot of money, experts suggest that we have benefited greatly in recent years by the increased use of generic drugs. Sources cited by the FDA suggest that “generic drugs saved the US health care system $1.67 trillion from 2007 to 2016” with about 90% of all current prescriptions in the US being filled for generic drug. That is way up from about 60% of prescriptions in 2005, so what happened to force such increased and rapid adoption among consumers?
This 2009 report is just one of many where researchers tried to gauge and understand consumer perception of generic drugs. They found 70% of respondents thought generic drugs were just as effective, but only 38% would rather take a generic versus a brand-name drug. Much has changed since the 2009 survey, and with the rate of generic use on the rise, it seems Americans are taking sort of a Pepsi Challenge based on drug costs. Health insurance providers and drug makers have incentivized generics, and consumers are finding that generics are providing the same benefit as name-brand drugs with much lower out-of-pocket costs.
One of the more interesting findings from the 2009 report was “the wealthiest patients—those with incomes greater than $100,000 a year—were more likely than poorer patients to report that they prefer generic medications.” Advocates for generics were aided by public awareness campaigns and information from government sources such as FDA and Medicare. While the wealthy were early adopters of generics, and there isn’t recent literature to compare to see if patient viewpoint is changing, the results of this challenge are clear that the combination of financial incentives and education has been effective in the widespread uptick in generic drug use.
Looking to the future, there are limitations in the use of generics; some are regulatory and some are scientific. Generics only enter the market on drugs where the initial patent protection has expired, meaning they are not available for recent innovations. Beyond that, some drug compounds can’t be made generic in an easy fashion because of their chemical makeup. Enter the new world of biosimilar compounds; biosimilars are the next generation of competing-use medications. In trying to compare a generic drug to a biosimilar, the pharmaceutical group Biogen has a great summary:
“A generic must be chemically identical to its branded counterpart and contain the same active ingredients. For example, the active ingredient in aspirin has only 21 atoms. Its make-up is easy to identify, and is relatively easy to copy, develop, and manufacture.”
“Biosimilars are much larger molecules derived from living cells, making them challenging to develop and manufacture. For example, a human-growth hormone biologic is made up of 191 amino acids with the equivalent of around 3,000 atoms. Other more complex biologics may consist of a protein composed of over 1,300 amino acids—the equivalent of about 20,000 atoms.”
Biosimilars open the door to competing versions of complex drugs made by many different companies that all treat the same disease or disorder but have enough variation in their complex make-up to not be identical from a patent perspective. Research is in the early stages and ongoing; there is a whole lot yet to learn about biosimilars, but it could represent the next wave of drug development.
Although, as biosimilars take off, so will the number of potential drugs on the market for consumers, which may mean a whole lot of new drug television ads. The very next Coke/Pepsi ad war could very well be between rival drug companies and that would make Super Bowl television ads very interesting.
Jason S. Brinkley, PhD, MS, MA is a Senior Researcher and Biostatistician at Abt Associates Inc. where he works on a wide variety of data for health services, policy, and disparities research. He maintains a research affiliation with the North Carolina Agromedicine Institute and serves on the executive committee for the NC Chapter of the American Statistical Association and the Southeast SAS Users Group. Follow him on Twitter. [Full Bio]
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