Patients who receive bad news about their health may be less inclined to buy generic drugs, according to the results of a Johns Hopkins University study published recently in the Journal of Marketing.1 The effect of bad news could result in 3% higher total drug spending per patient.2

Most specialists agree that generics have the same therapeutic value as brand-name drugs, but generics can be up to 80% to 85% cheaper than their brand-name counterparts, according to study authors Andrew Ching, PhD, professor of marketing, business and health, and Manuel Hermosilla, PhD, assistant professor of marketing, at Johns Hopkins Carey Business School in Baltimore, Maryland.2

Patients may consider brand-name drugs to be more effective and safer, but choosing cheaper generics could save the US health care system about $36 billion annually, according to investigators.2

Ching and Hermosilla undertook the study to understand how medicine-related insecurities, such as receiving bad medical news, influence patient choice over generic treatment options.2

They focused on low-density lipoprotein (LDL) cholesterol levels taken from a blood test, specifically the clinically defined borderline range (frontier) between near-optimal and borderline high (between 129 mg/dL and 130 mg /dL).2

Even if the cut-off level for bad news was 130 mg/dL, that didn’t mean that the individual was systematically less healthy.

There is a significant margin of error in measuring LDL, so the blood test was a good way to understand how bad news affected patient behavior.2

After collecting samples and informing patients of their cholesterol levels, the researchers observed that those who received a borderline high result (bad news) were 1.3 percent less likely than control patients to choose a generic drug.

However, given the ratio of generics to branded drugs on the market, this could translate into an 8% higher willingness to buy branded drugs.2

Bad news was also more likely to affect drug selection within the first 90 days of receiving the news.

The pre-loading effect occurred particularly in patients who bought a drug for the first time, discussed their LDL test results during a doctor’s office visit, or were healthier and surprised by bad news.2

The Johns Hopkins team conducted another similar study in which they analyzed drug claims made by patients with hemoglobin A1c levels between 6.9% and the 7% threshold, which indicates diabetes, and made similar observations.

Patients who received bad news in this case by learning they had diabetes were more medically insecure and more likely to choose a brand-name drug.2

Patients may choose the brand-name drug over the generic one because it is likely to be older. In Canada and the United States, it takes approximately 10 years for a generic to enter markets after the brand name is made available, during which time the brand name drug can gain influence.3

Data from a 2020 study examining how an agent’s perceived age influences drug selection supports this idea. Although there is a small segment of the population who choose the newest [generic]believing it to be more effective, most users find an older drug to be both safer and more effective, the researchers wrote.

In another study, from 2022, researchers manipulated a timeline of COVID-19 vaccine development. They observed that more people supported the vaccine if they thought the technology had been around longer than was actually the case.3

Patients may not choose generic drugs because they are not familiar with them; some study results suggest that 33% do not understand why generic drugs exist.3

Education could be as simple as sending a message to remind patients that generic drugs are therapeutically equivalent to brand-name drugs, Hermosilla suggested.2 Insurers and policy makers could also implement policies that incentivize the use of generic drugs.1

The latest study data shows that poor medical outcomes can trigger behavioral responses that impact healthcare systems.

Additional research including routine testing or patient diagnostics could increase understanding of how patient decision-making and spending affects the healthcare system.2

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