New research published in Annals of Internal Medicine assesses the cost-effectiveness of a generic-based regimen of antiretrovirals in HIV patients. Atripla a combination of three-brand name antiretrovirals, tenofovir, emtricitabine, and efavirenz, is the recommended treatment for newly diagnosed HIV patients. Efavirenz is expected to be available generically this year and lamivudine which is similar to emtricitabine is currently available. The researchers created a mathematical model looking at the use of these 2 generic medications in addition to brand name tenofovir. The authors concluded the use of generic medicines could save the US health care system close to $1 billion a year but the saving comes at a cost. The generic substitution will increase pill burden which could decrease adherence and put patients at risk of treatment failure. As a practitioner, how do you decide when to recommend generic versus brand name medications?

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