Do Doctors Tend to Recommend the More Expensive Medicine?

Hey guys,

A few days ago, I found out that I have Vitamin D deficiency. I went to the GP, had a blood test and was recommended the Ostelin pills, which cost around $25 for the 250 capsule pack:
https://www.priceline.com.au/brand/ostelin/ostelin-vitamin-d...

Knowing nothing about Vitamin D pills, I bought it (from the pharmacy next to the GP's place, NOT Priceline, but the price was similar).

Just today I went to the pharmacy for something else, and found out that Ostelin is actually the most expensive brand of Vitamin D pills. The cheapest one I saw is only $14:
https://www.priceline.com.au/brand/biosource/biosource-vitam...

The price difference seems substantial, given that the two bottles seem almost identical with the same ingredients. (Yes, as an OzBargainer $11 is substantial for me :D) I did a bit of googling and found that if anything, soft gels are better than hard capsules, as they are slightly easier to digest.

So my questions are:
- Does anyone know if/how the Ostelin Vitamin D pills are better than the other ones, which may explain their price difference?
- Has anyone had a similar experience of being prescribed/recommended expensive medicine, and later found out about cheaper, almost identical alternatives?

Thanks

Edit: Thanks for all the responses guys, this has been very helpful. I thought I'd do a TLDR version for anyone new to this thread:

  • It is worth asking your pharmacist/chemist for cheaper alternatives to recommended medicine, as it can potentially save you some money.
  • Doctors mostly just recommend the brand they are most familiar with, which is not necessarily the most cost-effective brand.
  • Doctors do NOT get kickbacks (at least not allowed to).

If anyone is interested, here is the full Code of Conduct from Medicines Australia. Sanofi, the corporate owner of the Ostelin brand, is a member of it.
https://medicinesaustralia.com.au/wp-content/uploads/sites/5...)

Comments

  • +2

    Every single time i have been to to a doctors/pharmacy i have been asked if i want the cheaper generic..

  • My doc usually diagnoses me, looks around the back and see if he has a freebie/sample and lets me have it rather than go to the pharmacist. But i have been his patient since I was a kid and hes getting old so the good times will be over soon.

  • +1

    There are absolutely no kickbacks/commission from any drug companies to doctors for prescribing a specific drug.
    Writing Ostelin on the script makes it simpler for patients as well as pharmacists. People are going to remember ostelin much easier than cholecalciferol (the active ingredient). One tablet of ostelin contains the correct dose of cholecalciferol (25mcg) which makes it easier for patients/pharmacists/doctors.
    It is the same as panadol (the brand name) and paracetamol (the active ingredient)
    Additionally there are over 100 medications in Australia which contain cholecalciferol at varying doses and with various other ingredients, not necessarily all solely for vitamin D deficiency. These range from 'TYR Anamix Infant Powder' which contains 30+ other ingredients to Dronalen Plus (which also contains alendronic acid- for other bone diseases)
    If the same dose, generally there is no difference between brand names/generics as the active ingredient (cholecalciferol) is the same. Some people can sometimes have reactions to the different ingredients that are also in the tablet as well.
    As many have stated, pharmacists always ask if you would prefer a less expensive alternative.
    P.S. I am a doctor

  • If the chemical name is so much harder to use in the prescription, why not say "vitamin D supplements"? Same with paracetamol, it's a common word.

    • Costs more ink to print then 'Ostelin'.

    • +1

      There are different types of vitamin D.

  • -1

    God, it's threads like this that make me cringe. Just listen to your Doctor. Stop being tight.

    • +2

      Did you just tell me to stop being tight on OzBargain? Really?

      • There are degrees of tight. There is searching for a bargain, and then there is neurotic.

    • +1

      You forget, you're in Ozbargain, where we try not to be unfairly taken advantage of by the retailer/manufacturer.

      If this thread was made a few years ago, when the opinions of doctors were able to be more directly "influenced" by the pharma companies, there's a clearer case to doubt the brand prescribed. Unfortunately, that can clearly haunt the profession years after that practice has been banned.

  • +2

    Maybe it is proof that advertising works…Panadol comes to my mind when we think of Paracetamol, so probably that is why it is recommended the most.

    • True ! Even if we think we are not paying attention to the advertisement, we are made to remember the name unknowingly.

  • I guess the issue here is, what is the "best practice" that doctors are meant to do. Are they doing a disservice to their patients if they prescribe a brand when they mean a generic? Does the Medical Association codify this?

    • +1

      I kinda think it's neigh impossible for doctors to know all generics out there and keep their knowledge up to date. Number of generics is increasing because patents expire. Isn't it kind of too much for the doctors to know every single generics out there and keep up to date? Besides, do the doctors prescribe specific brand or just active ingredient? I don't think I had any case where I was given specific "brand" on my prescription. That said, since I've not been to GPs a lot, maybe I am wrong.

      Besides, from what I've read here and from what I've seen, pharmacists usually ask you whether you want a generic or not (if not, then you can ask them for one anyways).

      • +1

        Appending the phrase "or equivalent product" after specifying a brand name would easily fix that.

        • All my cases with doctors, I don't think the doctor specified any specific brands. The doctors almost always told me what kind of med it was, but judging how I was always asked whether I wanted a generic in the pharmacy, I don't think I was ever prescribed with any specific medicine (but then again, it might be just me being lucky).

          There was one case when the doctor recommended me to change my body wash product, but when he mentioned the brands, he kinda said I needed to change to a soap free one and listed few brands he knew (he didn't go, I need to get Cetaphil per se, but said, soap free detergents like Cetaphil etc etc).

          Reading comments from above though, I think doctors are recommended to use generic names, it's just that it's easier for them to use brand sometimes. Besides, pharmacists usually ask whether you want generic if generic version of it do exist as far as I've seen. I think it's more sensible for the pharmacists to recommend generics, since they'd know what kind of generics are available at that moment (at least in terms of what they have in stock)?

        • @Oversimplified:

          As in your example, your doctor did mention that equivalent products are acceptable, which is essentially what I said. They don't need to know the name of a generic if they put in the language that allows it with the prescription.

          Expecting the pharmacist to re-interpret the prescription just makes the patient doubt whether they got the proper medication if the pharmacist suggested an alternative instead, especially if the patient didn't experience the expected results after taking it, as one commenter related above.

          This kind of ambiguity just makes the patient think that the promotion of one product over another has an undisclosed advantage for the doctor and/or pharmacist, or the pharmacist could be judged negatively for not taking the prescription literally.

        • +1

          @scupper: I assume what you are saying is pretty much recommended to the doctors (there is a comment that was saying doctors do get taught to prescribe generic names instead of brand names). I frankly think what you are saying is already in place and the doctor that the post is referring to probably made a mistake or just used brand name for the sake of simplicity or easiness to remember for patients (I assume prescription do not specify brands unless it is necessary from the comments on this post?).

          I kinda think pharmacists know enough to make that kind of judgment. They are not just simple retailers, but rather someone who have speciality in the field. They'd know what the active ingredient of the med that the doctor is recommending (and they probably have more knowledge on availability of generics and price of those). I may be opening a can of worm here, but that's my opinion at least.

        • @Oversimplified: Yes, I know. But that knowledge is only known by people in the business and for people like us who are getting it straight from the "horse's" mouth in forums like this. The typical patient has no idea and could go into various assumptions that do no justice to the people who are only trying to help him.

          My mention of the Medical Association is to also get certainty if this ambiguous use of brand names is actually "bad practice". If it's done for reasons of convenience, does it border on "laziness"?

        • @scupper: I personally don't think it's a malpractice. It's an easy way to convey information to the pharmacist and to the patient and pharmacists are specialists. If the doctors give out a prescription and if the pharmacists offer generics when you visit them, I don't see any problems to be honest.

          Patients are familiar with certain names and it is easier to remember certain names more. Someone did mention how cholecalciferol is not simply for Vitamin D deficiency and it is in many other meds that are for other reasons, therefore saying Ostelin kind of gives idea of what it is for (as it has certain dosage and is used for certain things). It's an easy way of conveying information.

          I don't disagree with less ambiguity being a positive thing, it's just that I don't see it being much of a problem and I don't see it as something that needs to change.

          Besides, I don't think this is a business secret or anything remotely like that. Existence of generic medicine in my opinion are known by many people. If anything during all my visits to pharmacists, I don't think there was any case when I wasn't offered a generic alternative. Even I've of it and I am an international student who visits GP around once or twice every year on average.

        • @Oversimplified: I don't think it's malpractice either, hence I didn't use that word, as it has a different meaning altogether. But it might be one of those things that is "frowned upon", especially now that transparency is required due to the misbehaviours in the past. Obviously this messaging system has been working well enough as something between doctor and pharmacist, but it discounts the patient as a messenger and observer of this communication.

        • @scupper: I've used the term malpractice probably too willy nilly. All I wanted to say was, I don't believe that this is so bad this should be considered as a disservice to the patient, a bad practice and an act of laziness.

          I don't think the patient was disregarded as a messenger, OP was given a diagnosis that he has a vitamin D deficiency and was recommended Ostelin for example. From what you are saying, it sounds as if the patients are given a drug name and no explanation whatsoever. I've never been to a doctor who've never explained the diagnosis to me nor not given me any ideas on what the meds are for.

          Doctors probably wouldn't know whether generics for certain medicine exists for certain, let alone whether it'd be available in the pharmacy that the patient is planning on going. Using brand name is an easy way to convey information to the pharmacist and to the patient and pharmacists are specialists, I assume. If the doctors give out a prescription and if the pharmacists offer generics when you visit them, I don't see any problems to be honest.

          I don't think the knowledge of generics is unavailable to the general public, I don't think the doctors give no explanations to the patients.If the doctor gives no explanation on his diagnosis whatsoever, I'd say that makes the patient oblivious to his treatment. Just from doctors using brand name out of convienience? I think that's pushing too far.

          I wouldn't disagree with usage of generic name over brand name, that said to make it into an issue that association has to get involved in… I personally see that causing more problems than fixing anything. If you want that kind of information, doctors probably would give you info on those if you just ask during your session.

        • +2

          @Oversimplified:

          Often, generic brand names can be difficult to write out because either:
          1. Pharmacist do not get the whole picture unless we write out a long string of dosage, frequency, duration, method of administration. Some of these things are common knowledge if they are fast turnover items. Ostelin is a very good example of that, Ventolin is another.
          2. Some drugs are combination drugs. It's easier to write one name than it is to list the active ingredients.

          In either case, it is the pharmacist's initiative to put you on an equivalent product.

        • +1

          no need, there is already something like this.

          [from memory] the prescription pads have a "generic brand substitution not allowed" tick box.
          e.g. if the doctor has prescribed Ostelin, and they only want the patient to have Ostelin, that have to actually tick that box.
          by convention, it is assumed by doctors and pharmacists alike that a generic option is adequate if the box isn't ticked.

      • Like with every profession, I don't expect the doctor to know everything on top of their heads, but as long as they use the resources available to them to give the patient the best possible advice. Whether that's looking through doctor's materials online or searching using their database, they will give you multiple alternatives if you ask for it.

        Most doctors will give you answers if you speak, otherwise, you miss out really.

  • +1

    Just a recommendation, I've been in a similar situation, however, my doctor gave me a prescription for a high IU dose of VIT D took 1 every month for three months and it cost me $7 AUD for the three pills.

  • +1

    I would assume that the doctors feel like a brand-name would work better. Maybe pharmaceutical companies or representatives from Ostelin have communicated their product's effectiveness? But all my years at my GP, they have always tried to prescribe what would work best for you. But, it's up to you to encourage conversation and not just say yes!

    IMO, it's up to you to do your research. Look at the ingredients to make a sound choice. I find Australian vitamins don't show what's exactly in their pills or softgel capsule. That's why I rather buy from iHerb. They label everything, even what the softgel capsule is made out of.

  • Its all about the availability and the product awareness, doubt there is any sinister motive behind this. =) If you ask the Doctor they will say the alternative is fine, if you can find it.

  • Not sure if anyone mentioned this but aside from price difference between generic and expensive one apparently some of the generics use cheaper / alternative ingredients. My mum uses prescription amoxil from a brand we have always used. She tried a generic brand instead and she had an allergic reaction to the generic one. Similar story to my sister who tried both a well.

  • Check out ebay. There are a lot of Ostelin sellers at a fraction of what you pay at the shops. Do some due diligence to find a reputable (local) seller. You should be able to find it for less than 10c / tablet

  • +1

    https://labdoor.com/

    My goto site for evaluating supplements. I usually buy from iherb since the local stuff is crap.

  • also note that doctors are typically rolling in it compared to most folk in australia, so they may not even consider the difference in price between brands as a factor

  • Buy the cheapest one with 1000IU. you should pay no more than $12 for 300-400 capsules.

  • -1

    Doctors do not get paid commissions or receive kickbacks from pharmaceutical companies to promote certain brands and products.

    But they do get loads of marketing material (just informing the doctors…) and heavily subsidized or even free trips to conferences. I'm sure pharma companies are spending that money without any expectation of favours in return.

  • +2

    The pharma reps that visit my friend's practice aren't exactly ugly…you do the math.

    On a side note my buddy got an umbrella from the AstraZeneca girls, it's sturdy!

  • -1

    You get what you pay for with everything. Dont know about Vit D tabs without looking into it but I know with other things eg fish oil, grape seed extract etc you definitely get what you pay for in terms of quality

    • +2

      Absolutely not true for all medicine. For medicines that have been under a patent for a long time, the brand name becomes so well-known that people will ask for the brand instead of the ingredient. They charge more for their brand in a way to recoup money from the patent after its expiry.
      Of course some pills may be easier to swallow/taste better/not stink as much but it often has little to do with the price tag.

      • -1

        Did heaps of research at the time when I was deciding on which vitamin brands to buy. They have different extraction methods and the levels of active ingredients varies etc.

        • For something like vitamins/fish oil, the method of extraction can vary. This isn't really 'medicine' but classed as 'supplements'. I agree though that the OP was given a supplement they need (Vitamin D) by brand name when the doctor should have just said how much vitamin D. I also realise you were talking about supplements and I suppose you do pay for what you get with that. Just trying to show it isn't for all medicines because a lot of drugs were patented, it introduces a new price element.

          Most medicine won't need extracting. Most medicine is focused on a specific issue and will have a specific dosage.
          Dosage of active ingredient is usually in big print at the front of the box/container so that's something that rarely changes. You'll notice a big change in price if it does change.

          For supplements dosage can vary because it depends on the persons diet and the reasons for needing a supplement.

  • It is like the doctor saying you should take a panadol. They don't know the generic brand names (eg. Panamax), that's up to the pharmacist because they stock them.

  • For vitamin D, D3 form I'd tend to buy up the Swisse version of the product when it is 50% off.

    Swisse works like other "fast moving consumer goods" at the big supermarkets with regular discounting cycles. 2 weeks ago they were 50% off all products at Coles.

    The no-name generics are cheapest on an 'everday' pricing basis. However keep an eye on the brands stocked at the supermarkets for cheaper pricing when 40 and 50% off occur.

  • What's with the national Vitamin D deficiency? I keep hearing from people who are finding that they are D deficient, many of them fair-skinned people who spend a lot of time outdoors not wearing burqas and not that diligent with the SPF50+ and suddenly they find they are Vitamin D deficient.

    is the test accurate or is it like the PSA test, fairly useless?

    • Test is accurate.

      There's a few factors in place.

      People absorb vitamin D differently. How often are people outside? Your body uses vitamin D3 everyday, so sun to indoors ratio might be low.

      Vitamin D3 is an oil soluble. Most of it is washed away when people shower with soap, since it takes 48 hours to fully absorb into the bloodstream.

      SPF only protects against UVB rays, which is what allows your body to produce vitamin D in your skin. Have to make sure the sunscreen used protects both against UVA as well as UVB.

    • are tests accurate? i was listening to a bbc podcast and they said if you send one blood sample to several different labs you will get back results ranging from low to high. their conclusion was that vitamin d tests aren't reliable.

  • I get this stuff. $15.70 for 360 5000 IU softgels.

    http://au.iherb.com/Healthy-Origins-Vitamin-D3-5-000-IU-360-...

  • +1

    Has the GP been wined and dined by Ostelin? No, of course not- perish the thought.

    http://www.abc.net.au/news/2015-07-07/doctors'-perks-from-ph...

  • +4

    Speaking as a Doctor myself, I can definitively say most (cannot speak for all) doctors prescribe either generic medication names (best practice) or well known brand names for no sinister/corrupt reason and this occurs predominantly due to:

    1) Physician brand recognition- most medications, especially those that have been on the market for a long time have 2,3,4,5… etc. associated brand names. It is hard, and not particularly important to keep up with every brand name that comes out- there are usually 1 (sometimes 2) brands that are far more recognisable.
    This is for several reasons:
    - Marketing and advertising investment. These medications are usually produced/sold/pushed onto the market by larger pharmaceutical companies.
    - Similarity to the generic name (ie. Amoxil for Amoxicillin or Keflex for Cephalexin)
    - Widescale production/sale in all pharmacies, supermarkets etc.

    Due to the above reasons/influences some brands have almost become synonymous with the generic medication (ie. Endone for Oxycodone)

    2) Patient recognition/trust

    -Most patients recognise brand names only and they are widely familiar with a few brand names of a few common medications, while not being especially familiar with generic names (ie. Panadol, Nurofen, Zyrtec).
    When discussing taking the above medications, I use phrases including "such as …" or "including …" or "other antiinflammatory drugs like …"
    This makes the conversation flow better when patients already have a clear understanding of what exact medication you are referring to. A large percentage of patients only trust brand names they are familiar with.

    3) Wide availability of common brands over alternatives
    A number of common over-the-counter or pharmacy-only nonprescription (and to a lesser degree prescription) medications are only available in a single, common, brand name, especially in smaller pharmacies. This forces the patient to buy this brand of medication, they ultimately trust this brand and are reluctant to use alternative brands in future.

    Admittedly, most of these common brands are more expensive than their generic alternative.

    Ultimately, doctors should try to prescribe the generic name when practical, especially for medications like antibiotics, and for the patient and pharmacy to decide whether to purchase generic medications or their more expensive brand name counterparts.

    It is, however, a ridiculous, and quite frankly offensive assumption that doctors prescribe expensive brand names because of kickbacks or significant benefits/perks provided by pharmaceutical companies. Although 20-30 yrs ago this may have been the case, it is certainly not the current state of affairs.

    • Do you see drug reps?

      • +1

        Working in hospitals, occasionally. They obviously try to market their products and present favorable evidence for them. Beyond providing sponsored lunch (usually food like sandwiches, subway etc.) during 5 minute presentations, there are no large gifts, flights, cash etc. It just isn't the case.

        Additionally, I, along with most doctors, ignore any information, evidence etc. they provide. Should they market product that sounds promising, I do my own research and I don't remember ever changing my practice or prescribing a new product I wouldn't have otherwise prescribed.

  • +2

    "Do drug reps affect prescribing?

    The issues above might not matter if doctors were immune to problematic information from the pharmaceutical industry. But are they? This is a question that several colleagues and I tried to answer recently in a systematic review. We collected all the available studies looking at links between doctors' exposure to information from drug companies and their prescribing.

    We found that, where links were found between information exposure and prescribing changes, they tended to be in the direction of more prescribing, more expensive prescribing, and lower quality prescribing.

    This doesn’t mean drug rep visits are never useful. I can imagine situations, when public health and commercial interests align, where reps might be helpful. But our thorough review of the world’s evidence gave us no confidence that this was usually the case."

    Brett Montgomery
    https://theconversation.com/why-i-dont-see-drug-reps-a-gps-t...

  • My friend who is a doctor always recommends expensive wine too. I don't think it's a conspiracy to have me spend more money more likely he has never known the pleasure of a $3.80 moscato.

  • I thought the idea of having a separate pharmacy from the doctor practice was meant to help prevent kickbacks.
    prescription and sale of medication is separated and there is no way to track who prescribes what.

    • Like any manufacturer, say Streets ice cream, they know which products are selling well at what area.

      • so it's a district, but who knows who prescribe what. so how do u link kickbacks to specific DR?

        the notion of kickbacks is not even a thing.

        • They don't try to as they also have privacy laws and codes of ethics to follow.

  • I don't know if they get kickbacks or not but I have definitely had times where one doctor has told me to get a medication costing me 50 bucks, while asking another doctor they said I only need this other one that was 10 bucks.

    I have a feeling they just recommend common brands or well known items not based on price, and well known ones are typically well known due to advertising and being more pricey.

    Take panadol for example, theres probably a lot of cheaper variations out there that do a similar thing as panadol, but if I had to recommend something for a headache, it would definitely be that. Even though its more expensive, its the only one I know of more due to advertising etc;

  • Another option is to try and incorporate foods with vitamin d into your diet eg. Fatty fish, milk, red meat, eggs. They only have small amounts so you would still need to take a vit d tablet, but would be good to incorporate them into your diet anyway. Foods with vitamin d mentioned here from our friends at Ostelin - https://ostelin.com.au/vitamin-d/?gclid=CIuLsu2cr8wCFRMHvAod...

    Also looks like Ostelin specialise in vitamin d and calcium supplements, which is probably why your doctor recommended them. Youd think if they specialised in it theyd be pretty good, not always the case maybe but theyre probably pretty decent.

  • "About Open Payments Data

    Sometimes, doctors and hospitals have financial relationships with health care manufacturing companies. Open Payments is the federally run transparency program that collects information about these financial relationships and makes it available to you. These relationships can involve money for research activities, gifts, speaking fees, meals, or travel. One of the ways we provide this data to the public is through this search tool, which allows you to search for a doctor, teaching hospital, or company that has made payments. Exploring this information, and discussing the results you find with your healthcare provider, can help you make more informed healthcare decisions."

    https://openpaymentsdata.cms.gov/about

    That's USA. There may be an Australian version but I can't find it and knowing Australia I doubt it is as transparent as the US one.

    • +1

      There isn't an Australian one because Australian doctors do not receive anything from pharmaceutical companies….it's legislated.
      It's frankly insulting to insinuate that doctors would compromise their patient's best interests for at most a free 30 cent pen.

      • It was open slather and hidden until very recently and still far from perfect. Get off your high horse.

        Not all doctors' perks to be made public

        By Ashleigh Stevenson
        Updated 7 Jul 2015, 7:48pm

        http://www.abc.net.au/news/2015-07-07/doctors'-perks-from-ph...

        Dr Moynihan said while the public database was a step in the right direction, there was a loophole.

        Under the new code any payment for food or beverages under $120 does not have to be declared.

        "That means your GP, your specialist, could be wined and dined every week by drug companies receiving dinners in the order of $100 a head and you will never know," he said.

        "The evidence suggests that often small gifts, innocuous gifts of small value can be just as powerful as large gifts or large payments.

        "That's why in the United States there's full transparency, anything over $10 is declared.

        "The loophole here in Australia is very worrying."

        He said more needed to be done in order to improve patient care.

        "We know there are something like 30,000 events a year in Australia alone where the drug companies are paying for the meals and alcohol of Australian doctors," Dr Moynihan said.

        "They are often being taken to Australia's best restaurants in the Gold Coast, Brisbane, Sydney, Melbourne, Perth, every town in Australia."

        Pharmaceutical companies will be required to report payments from October 1.

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