| Are Generic Medicines as Good as Brand Name? |
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And when it really matters The economy has made bargain shoppers out of all of us. And for many people, one of the most expensive things to do is go to the doctor. Generic medications’ cheaper price tags help. But there are some questions that need answering before we accept them as ideal budget savers. Are they the same as name brands? Are they safe? Effective? A good option in every case? Sometimes, the answer isn’t as simple as you might have been told. Drugs to QuestionThe Food and Drug Administration allows generics to be 80- to 125-percent as effective as the brands. That’s usually OK, but for drugs with a narrow therapeutic window—meaning exact dosage is important—it can be disastrous. For example, if your doctor prescribes 125 micrograms of Synthroid, you may get as little as 100 or as much as 156 micrograms from the generic. One hundred and 150 micrograms are themselves actual doses of Synthroid! This much variation makes it nearly impossible to ensure you’re getting an appropriate amount. For this reason, many physicians do not allow hormone substitution at the pharmacy. Here’s a partial list of drugs with a narrow therapeutic window.
Generics and the GovernmentMany Medicare Part D and Medicaid programs require generics, says Doug Hoey, R.P.H., chief operating officer of the National Community Pharmacists Association. “Most plans that I’ve seen do have some exception rule. However, finding a physician willing to go through the paperwork for free … is challenging.” When shopping around for a Part D plan each year, he suggests, “look at the different plans and see how they treat brand drugs.” MISLEADING CLAIMS The Food and Drug Administration assures us that generic medicines are “chemically identical” to their name-brand counterparts. They base this claim on the idea that they require generics to have the same safety and effectiveness as the original drugs. This is a bit misleading. Because name-branddrug companies have a right to protect their trade secrets, generic manufacturers often produce their products through reverse engineering. This basically means they make an educated guess about how the brand drug is made before producing a medicine with the “same” characteristics.
STILL GOOD ... USUALLY All this might lead some to conclude that generics are a bad thing. Usually, however, they’re a great option. In most cases, a small variation in active ingredients doesn’t pose a problem. “Generics are generally a win-win for everybody,” says Carl Labbe, R.Ph., a Walgreens pharmacist at Banner Desert Medical Center in Mesa, Ariz. “Remember, too, that a patient’s health may be severely affected by highcost drugs that are never purchased, or taken in subtherapeutic doses to make them last longer.” The important thing to remember is, although a treatment’s monetary viability is one critical element of the decision-making process, it’s not the only one. Other factors, like side effects, resistance (in the case of antibiotics), other medications you’re taking, allergies, other health problems you have, and how likely it is that you can properly adhere to the treatment are just a few of the things your doctor must consider. “Is there a generic you can write?” is a question patients increasingly ask. The answer is often, “Yes.” Occasionally, though, the generic option is simply not the best for the particular case at hand. In the end, the one person—besides you, of course— who is most likely to want you to recover as quickly, painlessly and inexpensively as possible is your doctor. Talk to him or her about your cost concerns. Your doctor is likely to be your best advocate in an ever-changing and financially challenging time. Matthew N. Parker, M.D. is an urgent care and family medicine physician in Hoover, Ala. “I’ll scratch your back …” Generics, pharmacies and profitsSay your doctor writes a prescription for a brand-name drug, but when you get to the pharmacy, you find that your insurance won’t cover it. Perhaps you should ask your friendly pharmacist whether the generic would be as good. That’s fine. Just know that your pharmacist may be getting a bonus on said generic. “I wouldn’t want to portray it as widespread, but there are a few [insurance] plans that give the pharmacist an incentive to dispense generic prescriptions,” says Doug Hoey, R.P.H., chief operating officer of the National Community Pharmacists Association, which represents independent pharmacies. And there’s a reverse penalty “that they’ll pay the pharmacy less if they don’t dispense a certain percentage” of generics. Then there’s your doctor. “I’ve seen letters sent to physicians from insurance companies saying, ‘You’re prescribing too many high-cost drugs. Stop it, or we’ll drop you out of our network,’” says Hoey. Most of the time, all this isn’t a practical concern when it comes to getting your prescription filled. Generics are fine and benefit you, too, since you’re saving money. But, as this article mentions, there are exceptions to this rule. If your doctor writes a prescription for a brandname medicine, “Always ask, ‘Is there a generic available?’” recommends Dennis Bryan, R.Ph., M.B.A., F.A.Ph.A., a pharmacist with WBC Pharmacies in Chicago. But, he says, also ask, “Would you give the generic to a family member?” and, “Would you use the generic yourself?”
Similar questions could apply when your insurance company covers a different brand than the one your doctor prescribed. Some pharmacy benefit managers— the organizations that run insurance companies’ prescription plans— have agreements with certain pharmaceutical manufacturers. The PBMs get discounts based on how much of the brand their members buy. “This helps lower the cost of the drugs for the plan, and ultimately the consumer,” says Megan Schiavone, a spokeswoman for the PBM Medco. But just like generics, brands differ and may not be appropriate for everyone. Perhaps the key is, “Find a pharmacy that you can trust,” says Carl Labbe, R.Ph., a Walgreens pharmacist at Banner Desert Medical Center in Mesa, Ariz. Find a doctor you can trust, too. Put together a good team who will answer your questions honestly, and you’ve got a great chance of both saving money and getting the best treatment. Comments (1)
  written by Lumosity Review , May 21, 2009 This is a darn good story. Definitely bookmarking this one. Write comment
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What They Don’t Tell You About Generics 
In fact, generic medications are only required to be 80- to125-percent as effective as the original. Because of this discrepancy, many doctors are a bit squeamish about prescribing generics, especially when it’s critical that the patient get a specific dose. This is particularly true for hormones like the thyroid medicine levothyroxine (Synthroid) and for blood thinners like warfarin (Coumadin), just to name a couple.
Brand Versus Generic
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