Doctors urged to prescribe more generics.

THERE may be a little extra incentive for your physician to write up that generic prescription.

While much of the focus in lowering pharmaceutical benefit costs has been placed on encouraging patients to try over-the-counter and generic medications, Health Net Inc. has rolled out a program that gives doctors a direct financial incentive to do so.

The pilot effort, called the Generic Medication Initiative, started in March and is monitoring the prescription patterns of 10 doctor groups around the state that are in line to share the financial savings if they write more generic and fewer brand name prescriptions.

"The initial results look good, and the feedback from the groups appears to be positive," said Bob Taketomo, vice president of pharmacy services Health Net's Western region. "There are really no ads on TV promoting generic drugs. What we are trying to do is promote them."

Health plans have been trying out several programs to counter the pharmaceutical industry's direct-to-consumer advertising and legions of sales representatives who make daily visits to doctors' offices.

One program that Health Net and three other large state HMOs jointly sponsor, called Generic Advantage, provides educational materials for doctors and discount coupons they could give to patients for generics.

Another plan rolled out two years ago by Blue Cross of California included measuring generic prescription rates as a small part of a larger physician bonus plan aimed at improving overall health care quality.

However, Health Net's generic initiative offers the group's 40 percent of the savings based on a quarter-to-quarter comparison of generic utilization. Another 40 percent goes to Health Net and 20 percent to the employer in the form of lower co-pays or premiums.

Taketomo said Health Net is already seeing a 7 percent increase in generic prescribing, a potentially large savings if the program were expanded. (Every percentage increase in generic drug use company-wide saves $3.5 million, he said.)

Physicians Medical Group of Santa Cruz, a 200-physician independent practice association, is one of the participating groups. Dr. Wells Shoemaker, its medical director, said the group could earn as much as $30,000 or $40,000 in bonuses through the program, money that will likely be split among the dozen top generic prescribers.

"That is no chicken feed. It's not enough to buy a yacht, but it's enough for a nice vacation," he said.

Shoemaker said he believes the program makes sense because generics work well for many patients. He said real incentives are needed to counter the barrage of drug company representatives who push expensive brand name drugs.

"If we are using more expensive drugs than less expensive ones we can use, it hurts patients. They are paying through the nose on tiered co-pays," he said. "I think the reason we were interested is that it was good for everybody."

Dr. Sophia Change, director of chronic disease management at the California Healthcare Foundation think tank, said she had not heard of the program but was not necessarily opposed to it, at least as a test.

"There is a huge cultural issue that needs to be overcome. Sometimes patients believe the brand name is better. It may require a financial incentive (for doctors)," she said.

Health Net expects to expand the program next year to more groups, Taketomo said.