title: Use of generic cardiovascular medications by elderly Medicare beneficiaries receiving generalist or cardiologist care.
abstract: BACKGROUND
  Elderly Medicare beneficiaries can reduce out-of-pocket spending and increase their options for low-cost Medicare Part D plans by using generic drugs. Physicians play a key role in determining use of generics and specialty may be a particularly influential factor.
  
  
  OBJECTIVE
  We sought to compare generic cardiovascular drug use by older adults receiving cardiologist and generalist care.
  
  
  METHODS
  We undertook a cross-sectional analysis of data from the nationally representative Medicare Current Beneficiary Survey. Included were community-dwelling adults 66 years of age or older with hypertension, coronary disease, or congestive heart failure, one or more Medicare Part B claims for outpatient visits with generalists (internist or family practitioner) or cardiologists, using one or more cardiovascular drug available in both brand-name and generic formulations (n = 1828).
  
  
  METHODS
  The primary outcome was use of one or more generic medication aggregated across 5 drug classes: beta-blockers, thiazides, calcium channel blockers (CCB), angiotensin-converting enzyme (ACE) inhibitors, and alpha1-adrenergic receptor antagonists. Within-class generic use also was examined. The main independent variable was cardiologist (20.7%) versus generalist-only care (79.3%).
  
  
  RESULTS
  In the aggregate, fewer individuals under cardiologist care used generics compared with generalist-only care (75% vs. 81%, P = 0.03; adjusted relative risk 0.89, 95% confidence interval = 0.79-0.99). Overall use of generic beta-blockers was 86.6%; thiazides, 92.0%; ACE inhibitors, 59.0%; CCB, 55.5%; alpha-blockers 47.7%. In adjusted analysis, generic CCB use occurred 34% less often among cardiologist versus generalist-only patients.
  
  
  CONCLUSIONS
  Older patients of generalists and, to a greater extent, cardiologists, often use brand-name drugs when generic equivalents are available. Promoting generic prescribing among specialists and generalists may increase opportunities for patients and third-party payers to reduce spending on prescription drugs.
authors.affiliation: Division of General Internal Medicine, Mount Sinai School of Medicine, New York 10029, USA. alex.federman@mssm.edu
authors.forename: Alex D
authors.initials: AD
authors.lastname: Federman
authors.forename: Ethan A
authors.initials: EA
authors.lastname: Halm
authors.forename: Albert L
authors.initials: AL
authors.lastname: Siu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002309:Cardiology; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000188:drug therapy*; D003430:Cross-Sectional Studies; D004363:Drug Utilization; D016568:Drugs, Generic / Q000627:therapeutic use*; D005194:Family Practice; D005260:Female; D006801:Humans; D007356:Insurance, Pharmaceutical Services; D008297:Male; D006278:Medicare; D010818:Practice Patterns, Physicians'
chemical_list: D002317:Cardiovascular Agents; D016568:Drugs, Generic