RT Journal
A1 O’Malley PG
T1 Systems-level interventions to improve value in prescription medication use: Comment on “physician acquiescence to patient demands for brand-name drugs”
JF JAMA Internal Medicine
JO JAMA Internal Medicine
YR 2013
FD February 11
VO 173
IS 3
SP 239
OP 239
DO 10.1001/jamainternmed.2013.3583
UL http://dx.doi.org/10.1001/jamainternmed.2013.3583
AB 
There is immense excess cost associated with using brand-name drugs when equally efficacious generics are available. For unclear reasons, a large proportion of physicians are reluctant to opt for the more cost-effective choices, especially if patients request brand-name drugs. Campbell et al find that social factors appear to influence medication decisions. Such situations call for systems-level interventions to overcome the irrational cultural practices. In this case, large, closed health systems with pharmacy benefits and managed formularies use pharmacy-level decision making on drugs, once the physician has made the decision on the appropriateness of the medication. These systems also allow for physician override when appropriate. Such systems-level interventions have immense potential to increase value in prescription medication use.