Although most doctors choose medications based on a combination of factors, below are some of the most common reasons a doctor might choose one particular medication over another.
1. Insurance coverage: Access to medications is highly dependent on decisions made by health insurance companies. Each insurance company has a panel of medications that are pre-approved for a doctor to prescribe. Other medications require prior authorization, which means your health care provider has to contact the insurance company directly to ask the insurance company to cover the cost of the medication. Even though your doctor might request prior authorization, sometimes the insurance company will deny approval or require that you take other medications (usually less expensive ones) that they have approved for coverage. This can be a timely and very frustrating process for both the patient and the doctor. As high deductible health plans (HDHP) are becoming more common, more people are faced with high out-of-pocket costs. An example of this is the current controversy over the exorbitant cost of the EpiPen, produced by Mylan pharmaceuticals.
2. Side effect profile: All medications have effects on the body. The wanted effects are called “treatments” and the additional, unwanted effects are called “adverse effects” or “side effects.” A doctor might choose to stay away from certain medications because of their general side effects or because they have knowledge that a medication will affect you adversely due to your particular health status or life circumstances.
- Serotonin reuptake inhibitors (SSRIs), such as Prozac, can cause sexual dysfunction. A couple that is actively trying to have a baby might prefer a different medication.
- Benzodiazepines (such as Ativan, Xanax, or Valium) may not be good choices for someone who drives a taxi because these medications can cause drowsiness and impairment while driving.
- Lithium, which is used to treat bipolar disorder, can cause renal dysfunction. If a patient has known kidney disease, a doctor may not want to prescribe this medication due to concerns of worsening kidney problems.
3. Doctor preference: After years of experience treating the same disorders, doctors can start to develop a preference or bias about which medications work better than others. The time period in which a doctor was trained can also affect his/her preferences because of the level of exposure a doctor has to learning about and using different medications. More recently trained psychiatrists have less experience using monoamine oxidase inhibitors (MAOIs), because serotonin reuptake inhibitors (SSRIs) are used more frequently now, due to fewer side effects.
4. Patient preference: Patients also have preferences or biases about medications. Some patients ask their doctor for a medication they saw in a commercial or a medication that was recommended by a friend or family member. Sometimes a patient will have heard a story about someone who had a bad reaction to a medication and will be afraid to take it, even if it is highly recommended by the doctor.
5. Availability of generic medications: When a new medication comes to market, the pharmaceutical companies have a patent, that allows only the brand version to be sold. A patent is valid for 20 years after the date it is filed, but it can take many years before a medication gets FDA approval to be used by the general population. The cost of the branded version of a medication is usually much higher than the cost of the generic. When the generic version becomes available, it is more likely that individuals and institutions will have access to these medications. Some examples of newer psychiatric medications include: Aristada, Rexulti, Vraylar, and Probuphine.