Episode 7 - Inclusion of Generic Drugs in Pathways

Peter Salgo, MD; John L. Fox, MD, MHA; Ira M. Klein, MD, MBA, FACP; Michael Kolodziej, MD; and Bryan Loy, MD, discuss the factors influencing the inclusion of brand name and generic agents in medical oncology pathways.

Dr Kolodziej explains that the results of randomized clinical trials have shown the equivalence of certain generic treatment regimens to regimens that incorporate branded drugs. However, despite these results, not all pathways incorporate the use of generics.

Providers consider many factors when selecting a branded oncology drug over a generic, comment Drs Kolodziej and Klein. The first consideration is minimizing toxicity, followed by safety; last comes economics, according to Klein. Patient-specific factors also play a role, adds Kolodziej. For example, trastuzumab is always included in pathways for patients with HER-2-positive breast cancer.

Dr Salgo notes that when making treatment decisions, providers often feel pressured to adhere to a pathway to ensure that treatment is covered by insurance. However, Drs Klein, Loy, and Fox explain that programs have been established to ensure that providers can still treat their patients outside of a pathway.