Effect of generic-only drug benefits on seniors' medication use and financial burden.

BACKGROUND: Generic-only drug benefits are a way to provide some coverage, as opposed to no coverage.

OBJECTIVE: To examine how switching from brand name to generic-only drug coverage affected seniors' medication use and financial burden.

STUDY DESIGN: Data are from a 2002 cross-sectional survey conducted for a separate study on benefit caps. Participants belonged to a Medicare managed care plan in one state and had $2000 capped brand name benefits in 2001 but generic-only benefits in 2002.

METHODS: Participants reported their cost-cutting strategies before and after the change to generic-only coverage, the medications affected, and their financial burden. We conducted bivariate and multivariate analyses of cost-cutting strategies and financial burden before and after implementation of generic-only benefits.

RESULTS: Among 611 participants (63% response), rates of switching medications increased after discontinuation of brand name coverage (27% vs 8%, P < .001). Switches were from brand name drugs to generic equivalents (14%) (eg, Prozac to fluoxetine hydrochloride), to nonequivalent generics (26%) (eg, Paxil to fluoxetine), and to different brand name drugs (45%) (eg, Paxil to Zoloft). Ninety percent of brand name switches remained in the same therapeutic class (eg, selective serotonin reuptake inhibitors). After discontinuation of brand name coverage, participants reported higher rates of decreased medication use (28% vs 17%) and greater difficulty paying for prescriptions (65% vs 37%) (P < .001 for both).

CONCLUSIONS: Changing from brand name benefits to generic-only drug coverage led many participants to switch to less expensive medications but also decreased medication use and increased financial burden. Insurers need to actively help patients adjust to a discontinuation of brand name coverage.