Sometimes people have concerns about the pricing of their prescriptions.
There are a variety of factors leading to this, but one of the big ones has to do with whether you are getting a brand-name drug or a generic drug. There are other factors, of course, but we will save those for another blog.
The U.S. Food and Drug Administration (FDA) defines a generic drug as “A drug product that is comparable to a brand/reference listed drug product in dosage form, strength, route of administration, quality and performance characteristics, and intended use.” (www.fda.gov) In other words, the generic version of a drug is (supposedly) going to have the exact same effect on the human body as would its brand-name counterpart. Both contain the same active ingredient, and have the same amount of active ingredient per tablet, capsule, ml of liquid, etc. Thus both would treat the same medical condition, have the same likelihood of effectiveness, and the same side effects.
There are differences. The INACTIVE ingredients in a drug—which are sometimes called excipients—may be different. A big one is dyes. For example, a brand name drug that is a white tablet may have a corresponding generic that is a blue tablet. Color of tablets, however, just about never has an impact on the tablet’s therapeutic effect in the human body. There is, then, no rule prohibiting the substitution of one for the other just because it’s a different color or has different inactive ingredients.
Some patients, however, have concerns about getting a generic medication. It is understandable. If it is not the exact same thing, and if it does not look exactly the same, will it fail to treat the medical condition in question equally well? Will it cause harm that the original brand medication did not cause?
Most of the time, the answer is no. A generic usually treats the same medical condition equally well without causing harm or side effects that the brand name drug is not known for. The FDA has put in place strict standards that manufacturers of generic products must follow. These standards ensure that the generic product is therapeutically the same as the corresponding brand-name product. While the brand and generic do not have to LOOK the same, they are expected to ACT the same. One standard is that the generic has to have 80 to 125 percent bioavailablilty of the corresponding brand-name drug. Bioavailability is defined as the percentage of drug consumed that actually reaches the bloodstream once inside the human body and thus is able to have an appreciable effect.
Perhaps the biggest difference between brand and generic medications is the cost. When insurance is asked to pay for patient’s prescription, insurance will usually make the patient pay a lower copay for a generic and a higher copay for a brand-name drug. Why? If the two drugs are therapeutically the same (or 80-125% the same), then why pay more for the brand if you’re not getting more? When a prescription is filled, then, for a brand name drug, often the insurance will still accept the claim (and not reject it), but they will make the patient pay a higher co-pay that includes the difference in cost between the two products. Here’s a hypothetical example: You might have a prescription for a cholesterol medication. Thirty tablets cost $600 without insurance, and thirty generic tablets cost $100. The copay for the generic might be $20. When the prescription is billed to the patient’s insurance, but insurance is told that the patient asked for the brand, they might accept the claim, but if they do they could charge the patient $520. ($20 copay plus $500, the difference in cost between the brand and generic without insurance.) More often than not the increase in copay is not that drastic, but I have seen cases like this in my experience.
There are several medication classes where switching to a generic is not looked upon favorably. One is thyroid medication. A study was done in 1997 to confirm that Synthroid and its corresponding generic – levothyroxine – were bioequivalent. By bioequivalent we mean that one drug would have the same ingredient and effect as would the other. Although the study confirmed that the two drugs were bioequivalent, a number of patients and prescribers began asking for brand Synthroid. To this day some patients still refuse the generic product. It is important to note that when a prescriber writes “Brand necessary” or “Dispense as Written” on a prescription, the pharmacist by law must comply and must not give the generic to the patient.
If you have concerns about the costs of your medication and/or whether or not generic medication is right for you, I would recommend you do three things.
First, talk to your insurance company. Do the best you can to get from them how much they will expect you to pay for your prescription, especially if there is a generic available and you want the brand. You have every right to get the brand name product, but some prescription insurance plans may still want you to pay the difference in price between the brand and generic products.
Second, talk with your doctor or other prescriber. With certain medications, doctors want their patients to get the brand name product. Often this is because they are aware of research or experiences showing that the generic did not work satisfactorily. If you want the generic, you need to make sure your doctor has no objection.
Third, talk with a pharmacist. Pharmacists usually know the differences, if any, between brand and generic products, and how the pricing works.
If you have any questions or comments please feel free to let me know.
Thank you for reading.