Doctors May Not Reveal Full Truth Behind Rx Switch

Team 5 Investigates has obtained documents that demonstrate the extraordinary lengths to which some doctors will go to switch patients off of the country's top-selling cholesterol medication, on to less expensive generics -- to the financial benefit of the doctors.

NewsCenter 5's Janet Wu reported Sunday that doctors may not be telling their patients all of the reasons behind the switch.

The memo obtained by Team 5 Investigates appears innocuous. Doctors throughout the state have received similar ones, instructing them to switch as many patients as possible from the more expensive Lipitor to generics like Simvastatin, Pravastatin or Lovastatin, medications they admit are not the same.

They're "not as powerful," said Dr. Thomas Lee, the CEO of Partners Healthcare, Inc. "But the vast majority of patients you can get to goal with Simvastatin and if you can get them to goal for less money, less money to society, less money to them out of pocket, that's what we should do."

Less money for everyone except physicians.

Many doctors get a financial benefit from insurers through a complicated formula if they switch enough patients off of brand names to generics. Patients see that they are saving money on co-pays, but do they know their physicians are making money?

Dr. Gregory Martin, chief medical officer of Emerson Hospital, said everyone benefits .

"The insurance company benefits. The patients benefit and the providers benefit," Martin said.

But Regina Herzlinger, a Harvard Business School health care expert, counters, "The patient has to know that the doctor has a financial incentive in making the switch. If the patient doesn't know, the doctor is not acting as a professional physician."

Emerson Hospital, in Concord, is taking its effort to maximize financial incentives a step further. Earlier this month, it instructed physicians in its network to "mail the automatic switch letters provided to the patient … if (there is) no response from the patient after three weeks," then doctors were instructed to call the patients' pharmacy and "change the prescription to a generic alternative."

"I guess I don't see an ethical issue there," said Emerson Hospital's Martin. "Patients have it done for them so they don't have to take any active steps. It's meant to be a convenience."

But even the head of Partners' physician network, of which Emerson is a member, frowns on this system. Lee said, "Ah, I get what you're getting at, the patient has to act to prevent something from happening. I feel a little nervous about that."

But Lee defends the practice of moving patients off Lipitor, saying doctors' own financial gain is not the primary motivation. "For any individual doctor, they can never figure out if I give you this generic, instead of a brand prescription, I'm going to take home X dollars more," Lee said.

Wu: "But they also know the more patients they switch over to a statin or over to a generic that at the end of the year, their practice will benefit financially, no?"

Lee: "You know, if they're more efficient, they will benefit."

Wu: "Financially?"

Lee: "Yes. That's true. Right."

Still, other doctors complain that what insurance companies consider efficiencies are anything but. They said the paperwork is overwhelming, and if they do not switch patients' prescriptions, they have to explain why to the insurance company.

Then, there's the expense of retesting only to discover the generic didn't work for some.

Dr. Robert Friedman, of Middleboro, said, "I've seen in many of my patients who have been switched; not only has their cholesterol gone up, but their trigylcerides have gone up." This, he said, leads to more paperwork, more testing and more cost to patients.

Earlier this year, a Team 5 Investigation revealed that doctors in Michigan were being paid $100 for every patient they switched off Lipitor to a generic of one its competitors, Zocor.