New lesson learned...

[Waydwnsouth1]

I had my lortab refilled last month and noticed the pills were different. I thought the normal supplier could not supply the drug so they went to a different supplier. Then I noticed the effectiveness of this drug was not what I had in the past. So I mentioned it to the pharmacy tech and she said oh we are giving out the blue ones until we run out then we are going back to the pink ones. I said really and why would you do that? She said they are phasing that company out and we are trying to get rid of our inventory.

Well that did not anger me because they take really good care of me at this pharmacy. So when I dropped off my new rx today I asked for the pink ones and I got them. What a marked difference in the pain control from one pill to the next even if is supposed to be the same drug. I guess that says alot about generic mfgrs.

[Spydre]

I used to work at legal aid, and part of what we did was help people with issues with Medicaid. I learned (from numerous clients) that brand name Tegretol works much better for trigeminal neuralgia than the generic (unfortunately there was nothing we could do about getting Medicaid to cover the brand name). Also, when Keppra went generic, I had a seizure, and my neuro attributed it to being on the generic, so he prescribed me the extended release version to keep me on the brand name.

[onlyairfare]

I think that the FDA definition of "generic equivalent" is that the generic must be within 80% to 120% of the brand name drug content. Brand name manufacturers usually maintain tight manufacturing standards so that the drug content of a pill is within 97% and 103% of what it says on the label.

For many or most drugs, a 20% variation either way does not make a big difference, but for some it does - especially anti-epileptic drugs. Thus, your real dose of Keppra may be 1,000 mg, while the generic "equivalent" of levatiracetam might be only 800mg. Presto - you start having seizures because you do not get enough medication.

[celloyogi]

Generic medication must contain the same active ingredient. The main issue is bioavailability; that is, how much of the active ingredient is in the bloodstream after a given period of time. The FDA allows a 20-25% variability in bioavailability between brand and generic. In other words, a brand and its generic are considered bioequivalent if rate and extent of absorption of the generic is between 80% and 125% of the brand.

This percentage may not matter much for some medications (such as antihistamines or statins), where small dips or increases won't pose an immediate problem.

In other situations, these small dips and increases can have potentially serious consequences. Examples include anti-epileptic drugs (AEDs), thyroid meds, and some blood pressure meds. The American Academy of Neurology issued a formal statement that generic AEDs should never be substituted for brand AEDs without the consent of both the patient and the treating physician. Other medical groups have or are in the process of developing similar statements.

Brands are, of course, more expensive. My own insurance, for example, will not cover brand drugs without prior auth. I can however pay the difference between my generic copay and the cost of the brand name (which for my Lamictal alone would be several thousand dollars). I have prior auth for several of my meds because the generics cannot be guaranteed gluten free and I have celiac disease. I am lucky in that respect.

But what about patients who have always had brand and suddenly a generic is available? They're stuck with several thousand dollars for a med, or a potentially more expensive bill when they have a seizure and end up in the hospital - such cases have been reported due to switching brand-to-generic.

And don't get me started on formularies. An insurance company requiring patients to try "therapeutic alternatives" and/or a list of "generic equivalents" before covering the drug the prescriber feels is most appropriate, is ridiculous. Some patients might be screwed for weeks/months before insurance will cover the drug the patient really needs. Example: Blue Cross considers ibuprofen a "therapeutic alternative" to Celebrex. Both are NSAIDS, both reduce inflammation, but they work differently (Celebrex is COX-2-specific, ibuprofen is COX-1 and -2, possibly others). They are not the same medication. The insurance company basically is saying the patient has to try the ibuprofen first for a given period (usually at least a month), and the healthcare provider has to show that the patient "failed" (continued to have pain) that medication before they will cover Celebrex.

Many states have laws requiring a pharmacy to dispense a generic unless there is no generic available, or unless the prescriber has specifically indicated Dispense As Written on the Rx. Between that and the insurance companies refusing to pay for brand, it's the bean counters practicing medicine.

If all we have are generics, there will be very little profit in the drug industry. Money fuels innovation, and without the promise of a decent profit, the likelihood of development of new and better treatments will plummet.

Hot button topic for me, obviously.