Replacing Brand-Name Cardiovascular Drugs Could Save Patients Money

Pharmacy TimesFebruary 2022
Volume 88
Issue 2

New analysis shows the substitution would cut costs by $600 million in the United States annually.

Prescribing generic medications rather than brand-name medications to treat blood vessel and heart diseases in Medicare Part D could save more than $600 million each year in the United States, according to a study published in Circulation: Cardiovascular Quality and Outcomes. “Research shows that when passed on to patients, high prices reduce medication adherence and can lead to negative health outcomes,” said Elliott Marshall Antman, MD, FAHA, former president of the American Heart Association (AHA), chair of the writing group for the AHA’s 2017 presidential advisory on medication access and affordability, and senior physician specializing in cardiovascular medicine at Brigham and Women’s Hospital in Boston, Massachusetts, in a statement. “Patients’ health suffers when they can’t afford the medicines they need.”

To conduct the study, investigators gathered data on prescription-filling patterns, comparing brand-name medications that prevent or treat blood clotting, high cholesterol, high blood pressure, and irregular heart rhythms with their generic counterparts. Using records from Medicare Part D prescription coverage, which applies to all adults older than 65 years in the United States, the study authors reviewed prescriptions filled in 2017 for cardiovascular medications that are available both as brand-name and generic formulas. Medicare Part D paid nearly $23 billion for cardiovascular medication prescriptions in 2017, with $11 billion of that spending put toward medications available in both brand-name and generic formulas, according to the results of the study.

Although just 2.4% of prescriptions filled were for brandname medications, they accounted for more than 21% of total Medicare Part D prescription spending. Furthermore, 8.2% of the prescribing physicians reviewed in the study who prescribed generics the least could potentially account for 50% of the available cost savings estimated by the investigators.

After controlling for cash rebates available for some of the brand-name medications with available generic formulations, the investigators estimated that increased use of generic substitutions in Medicare Part D could save $641 million per year. This includes approximately $135 million in out-of-pocket cost savings to patients. “Increasing the use of generic medications would decrease patient out-of-pocket costs and make medications more affordable, which may, in turn, improve adherence rates and reduce the financial burden of medication therapy,” the senior author Alexander Tarlochan Singh Sandhu, MD, MS, instructor of medicine at Stanford University School of Medicine in California, said in a statement.

In certain states, laws require pharmacists to seek patient consent before substituting with a generic. Other state laws mandate that pharmacists substitute a generic unless it is indicated by the physician that the prescription must be dispensed as written. “Generic substitutions have similar efficacy as brand-name options. However, there may be misinformation and hesitation about the safety and efficacy of generics,” Sandhu said.

“FDA regulatory oversight into the safety and efficacy of generic substitutions is critical for improving the use of generic medications. Ensuring patients almost always receive the generic option will further reduce patient out-of-pocket costs,” Sandhu said. “Health care systems should continue to find ways to encourage clinicians and patients toward generic medication options when available.”

The investigators listed multiple limitations to the study results. Only Medicare Part D prescription coverage was reviewed, which includes only adults 65 years or older. Additionally, the study did not account for dosage differences, and it included generic substitutions even if they were more expensive than the brand-name formulation with cash rebates considered.

The 2017 presidential advisory on medication access and affordability from the AHA states that the costs of medications should be readily available for patients and practitioners so they can make informed treatment decisions. Tools that detail information on the pricing and value of medications would help both health care professionals and patients make decisions in selecting care regimens that best align with patient and family goals and preferences, according to the advisory.


Use of generic heart meds in Medicare Part D could save more than $600 million a year. News release. American Heart Association; December 9, 2021. Accessed December 15, 2021.

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