By Valerie Bauman, Associated Press Writer

All the doctors had to do was show up, enjoy a free dinner at an elegant Rochester, N.Y., area restaurant specializing in steaks, chops and top-shelf wines, and pocket $100 on the way out the door.

Health insurance companies had invited the physicians to hear a pitch about the benefits of prescribing generic drugs instead of their pricier, name-brand competitors.

Meet the flip side of a concern about corporate influence in the doctor’s office that’s been criticized — often stridently — when the pharmaceutical industry entices doctors to prescribe brand-name drugs. Under pressure, that industry has since reined in its promotional efforts.

But insurance companies are allowed to push doctors toward cheaper prescriptions, frequently by offering the physician a form of bonus, a cut from the savings that insurance companies get when doctors prescribe generic drugs.

For example, Independent Health, a Buffalo, N.Y.-based insurer, offered doctors who prescribe 70 percent or more generic prescriptions in a month a bonus of 50 cents per patient per month. A doctor seeing 500 patients per month who meets the 70 percent minimum can collect $3,000 a year.

Some states want to more closely monitor the relationship between insurance industry representatives and doctors. In Massachusetts, a pending bill would regulate incentive plans between insurance carriers and providers. A Michigan proposal would ban financial incentives in exchange for prescribing a generic medication. That measure would allow insurance companies to compensate doctors for the time it took to evaluate whether a switch was best for the patient.

In New York, state Sen. Jeffrey Klein introduced legislation that would prevent insurance companies from offering physicians incentives. A grandfather clause would require HMOs to continue providing brand-name drugs to patients already benefiting from it. But none of these bills have gotten serious traction in state legislatures.

Last year, the American Medical Association warned that it considered the bonuses kickbacks and said doctors who accept payment from an insurer for switching a patient from a brand name to a generic drug could potentially face criminal and civil liability under federal statutes.

And caught in the middle, physicians warn that when a medical decision is taken out of a doctor’s hands, it can hurt patients, such as 77-year-old Emmett Curran of Lynn, Mass.

After 10 years of taking the cholesterol medicine Lipitor, which has no low-cost generic equivalent, Curran’s new insurer under Medicare refused to cover it. They insisted he take the generic equivalent of a completely different drug and he was scared.

“I’m not 25 or 30,” he said. “There’s something that’s working for me with no side effects, why do you want me to experiment?”

Insurers say they encourage generics because it keeps consumer costs down when health care expenses are spiking. Companies argue that patients sometimes won’t stick to their expensive prescription to try to save money, and a generic alternative could keep their regimen consistent.

 

On the Net:

www.medicare.gov

To find programs that will help you pay for your medication:

www.pparx.org/Intro.php