A latest study published online by the JAMA Network on May 09, 2016, states that the use of therapeutic substitution in the provision of the drug therapies could prove economically beneficial and might result in saving billions of dollars. This could result in the improvement of the overall healthcare system as the drug therapy for different diseases could become more affordable for the patients and the health insurance companies.

The study found that through the years 2010-2012, an extra amount of US$ 73 billion was spent on the branded medications for different therapies, which could have been saved by therapeutic drug substitutions. This concept can now replace the current practice of generic substitution, which is another method for the reduction of treatment cost when comparing generic vs brand drugs. It is noted that it is proving to be worthless spending more money on the same desired health outcomes when other cheap options are available.

Therapeutic substitution means that drugs within the same pharmacological class are interchangeable, even though they are chemically different from each other. These drugs can be interchanged therapeutically as the desired effects or outcomes associated with their use are same. Whereas, generic drug substitution means substituting the prescribed brand product with a less expensive but chemically equivalent drug after the expiry of the patent. One of the major advantages of the generic medication is that it can be economically very beneficial for the consumers as the manufacturers have to face the market competition for the same drug.

For further clarity, any expensive branded proton pump inhibitor (PPI) can be replaced by another less expensive generic PPI belonging to the same class for treating peptic ulcers or acid reflux. These drugs can be chemically different from each other but the desired outcomes could be same. This is therapeutic substitution. The brand Nexium can be replaced by another generic esomeprazole from any other manufacturer or importer and this is known as generic drug substitution. The generic substitution can only be done after the expiry of the patent duration of that product.

Jonathan Watanabe, who is an assistant professor in the Skaggs School of Pharmacy and Pharmaceutical Sciences at San Diego, states that, “It’s been demonstrated in several studies that there’s a lot of money being left on the table, because we’re not using generics as effectively as we could be.” He further stated that the estimates of the study are correct and the implementation of the substitution will actually improve the health of the general public and the treatment would become affordable for most of the patients. However, for that to come about, current laws regarding substitution need to be changed.

In the recent study published on May 09, 2016, in JAMA Internal Medicine, the authors, namely Michael E Johansen of Department of Family Medicine, College of Medicine, Ohio State University at Columbus and Carolina Richardson of the Department of Family Medicine, College of Medicine, University of Michigan at Ann Arbor, estimated the amount of money that could be saved through the implementation of therapeutic substitution, especially when for a particular brand, other generics of the same class are available.

Their findings indicated that therapeutic substitution can decrease the total expenditures related to the drug products and can help in improving the overall efficiency of the healthcare system. The study aimed at estimating the potential savings in terms of the expenditures. These expenditures can be categorized into two classes i.e., total expenditures and out-of-pockets expenditures. The study was designed by collecting the data of 107,132 patients along with the drugs and the prescribed use from Medical Expenditure Panel Survey conducted from 2010 to 2012. A repeated cross-sectional study analysis was performed on the patients’ data. Further information was taken from the US FDA, different resources and other research literature available.

It was found that the overall expenditure was increased by US$ 73 billion when the other cheaper therapeutic substitutes were available for the same diseased condition during this period. Similarly direct out-of pocket cost of the drugs that the patients had to pay amounted to US$ 24.6 billion. The classes of drugs that were associated with high excessive treatment costs included statins, atypical antipsychotics, PPI, selective serotonin re-uptake inhibitors and angiotensin receptor blockers. All of these classes exhibited the extra expenditures worth US$ 10.9 billion, $9.9 billion, $6.12 billion, $6.08 billion and $5.53 billion respectively.

The authors concluded that therapeutic substitution could reduce the treatment costs significantly without affecting any health outcome of the therapy. Although this conclusion is opposed by many healthcare professionals, since it can affect their independence and is also considered controversial because of the potential drug-drug interactions occurring with other medications that a patient can take for multiple complications, yet, from economic point of view, it could be beneficial if properly implemented.