Is the Rate of Generic Drug Prescribing a Fair Measure for Pay for Performance?

Prescription drugs are a significant and rising component of healthcare costs. To limit this expenditure and maximize cost savings, half of the pay-for-performance health programs in the US reward generic drug prescribing once the patents on brand-name drugs expire. This article discusses arguments for and against the rate of generic drug prescribing as a fair measure for pay for performance from both provider and patient perspectives. Compared with brand-name drugs, generic drugs are usually cheaper to purchase, can avoid confusion over different names for the same drug, minimize commercial influences from drug manufacturers, and can allow pharmacists to dispense any medicine that meets the necessary specifications. However, saving money may be a responsibility of governments and payers rather than providers. Some providers and patients are uneasy that financial incentives for generic prescribing may not directly aim to improve patient care and may motivate providers to put their own financial interests above the welfare of patients. It has not been proven that the financial incentives are large enough to change prescribing behavior or that generic drugs are less safe or less effective than their brand-name counterparts. However, there are legitimate concerns around bioequivalence standards, and some providers and patients object to attempts to compromise their autonomy. High-quality care requires not a rigid adherence to performance indicators but a careful and flexible balancing of provider and patient interests. A final concern is patient non-adherence or mistakes in adherence following a change to a generic drug. It is uncertain that pay for performance is the best way — or a fair way — to contain spiraling health costs.