Team 5 Investigates discovered that health insurers are giving doctors cash incentives in some cases, to switch patients from name brand to generic prescriptions.
The payments are legal, but health care experts said they clearly raise ethical questions if patients are not told the reasons behind the switch.
Earlier this year, Blue Care Network of Michigan paid 2,400 doctors $2 million to switch their patients from Lipitor, the most-prescribed medicine in the world, to a generic version of its competitor, Zocor. Doctors were paid $100 for each patient they switched from January 1 through March 31, 2007.
"Without saying to the patient, 'I have a financial incentive in making this decision, which goes along with my professional incentives to do what's right for you,' it's unethical," said professor Regina Herzlinger, of Harvard Business School. "It's a clear conflict of interest."
Team 5 Investigates asked Blue Care Network of Michigan if patients were told of the financial kickback. A spokeswoman said "not specifically."
In Massachusetts, financial arrangements for switching patients from Lipitor are less blatant, but they do exist.
In a letter obtained by Team 5 Investigates, Partners Community HealthCare's Medical Director, Dr. Thomas Lee, told his colleagues that "physicians will increasingly be rewarded in our pay-for-performance contracts if we increase the percent of generics we use. Increasing our use of generic statins is therefore very much to our advantage."
In Massachusetts, arrangements vary according to the insurance plan. Some doctors get a cash bonus at the end of the year for various money-saving practices, including switching their patients to generics.
Dr. Robert Fraser, said he moved most patients off Lipitor because they would save up to several hundred dollars a year on co-pays. He said he gets a kickback for only some of his patients, depending on their insurer.
"Well, the problem is I don't know which patient I'm seeing at that moment. If you walk into my office and at that second, I don't know if you're an HMO patient or not."
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