Patient Stories About Generic Drugs

Like almost everyone else who uses medicines to improve or maintain their health, I take a large percentage of  generic drugs. Up until the last few weeks I have not noticed any difference in the effects of brand name vs generics.

                                           Generic drugs 

Unfortunately that is not the same for everyone, and now I am joining their ranks. One of the drugs I take recently just became a generic and I noticed a real difference quite quickly.

With most medication you judge the efficacy by a gradual change in the way you feel or by lab tests that indicate how well they are working in your body.  So many drugs that we take are preventive or work slowly on changing your system. With those you are unlikely to notice a difference. This new generic (Pilocarpine, brand name Salagen) is the only one I take that takes effect quickly and has a noticeable physical effect.

                                   Non-generic - see markings
My doctor wrote me a note and a new prescription that says "no substitutions". The insurance company says fine, if the doctor says I need the brand name they'll pay (and so will I of course) so that is lucky for me.

Neither the doctor nor the pharmacy mentioned reporting an adverse effect for this new generic. I was able to access the 32 page monograph that the new manufacturer supplied to Health Canada. They listed every paper about the drug from the past and talked about how the drug worked in trials compared to the brand name drug. They only tested the effects on 5 women. I guess I'm not like them.

Patty's Story:

"I am taking the generic Prevacid and I don't like the effects.  It upsets my stomach.  I stopped taking it.  I don't know which one would be easier on my digestion.  I don't think I ever got the brand name Prevacid though I do hear the acid reducers are hard of the gastro tract. 

I haven't been able to get Prevacid..still jumping thru hoops for that.  I'm not taking anything....just sort of po'd.  And not doing a thing about it.  I'm trying out the 2nd manufacturer but really not.   The pharmacist says if the Dr pre authorizes it, I can get it but he already did pre authorize it and I still was denied.  I am still waiting for approval on the Reclast....  I think they hope I break my hip or leg first. Then they'll approve it. 

                                                 Patty is angry in a non-threatening way

I'm just so mad....I don't know when the patient had to be their own doctor, secretary and insurance company to make sure you get the things you need."    

Julie's Story

"I am going to add my experience with the generic of Prevacid to Patty's reply.

I have Barrett's esophagus - thanks to use of NSAID's.  This is a pre-cancerous condition.  The doctor put me on Prevacid and it really helped.  At a follow-up endoscopy, he could barely see anything in my esophagus.

Well, my insurance company switched me to the generic of Prevacid - Lansoprazole.  I tried that for about a month and started having GERD symptoms.  After much confusion and doctor's visits, my insurance company agreed to pay for the Prevacid.  I started back on the Prevacid and things returned back to normal.  So no one can tell me that the generic works like the Brand name drug.  I had to get special permission from the Insurance Company to get them to pay for the Prevacid.  I told them that if they would rather pay for treatments for esophageal cancer instead of the correct medication, then that was their choice.  I have to get approved every year.

                                   Please approve my brand name drug

The Prevacid is EXPENSIVE!.  I don't quite understand why.  Another thing is that Prevacid is sold OTC - but the strength is 1/2 of that of the prescription medication.  I take 30 mg and the OTC is 15 mg.

Insurance companies are really getting screwy with what they will allow their patients to have."

Julie

Patty continued...
My Caresource insurance lady was telling me about Exact Care where you get your meds in an easy tear off pouch all tightly wrapped and inside a little cardboard box.  All your meds for the month are there...just tear them off as the day goes along...am pills, lunchtime,  afternoon, PM and evening, bedtime.  She asked would you be interested in that? Its so convenient.  I said no way....they're already substituting my meds when I pick them up at the pharmacy. Or switching manufacturers on me.  I want to see what I'm getting and I don't want a month of a med or two that they've subbed that may make me sick or is totally different than what I am used to.   

Ronny's Story:

"I guess you are proving my point.  The move is towards saving money first and finding healthy resolutions second. 

Many years ago it was predicted that this time would come.  Health would be the big commodity and everyone began positioning themselves to make out like bandits.  The health center I worked for had big meetings to discuss how they could position themselves to take advantage of the health boom and also baby boomer aging.  They got in early.

Now we have to fight to keep what little Social Security we have.  I was hoping I could afford more fruits and vegetables.  Guess that's not happening!"

                       AmusingPlanet.com Harrowgate Flower Show. Fruit&veg for Ronny

Here's another story about generics from CNNMoney - Are Generic Drugs Really The Same as Branded Drugs? . This story points out that although generics compared to the brand name they are not compared to one another so the relative usefulness is unknown.

This is the link to the original post called Generics: Not Just an Image Problem

Generics - It's More Than an Image Problem

There was an article called "Bad Rap on Generic Drugs" in the New York Times on October 5th, 2013. The article found a lot of skepticism about generics, not only among the poor and disadvantaged but also among doctors. In this study designed to "understand barriers to cost-effective medicine use," 50% of doctors who responded to a survey had "negative perceptions about the quality of generic drugs." Dr. William Shrank is the lead of 6 authors listed on the paper.  Three of the remaining five authors are employees of CVS Caremark which also provided a research grant for the study. 

The New York Times article by Katie Thomas went on to discuss other cases that might lead to a lack of faith in generic drugs including the Ranbaxy settlement, and FDA warnings about generic Wellbutrin. These are not the only generics that do not have the same effects as the original brands.

                                   

                                                     
Dr. Shrank is quoted in the article as the lead author of a paper titled "Patients' Perceptions of Generic Drugs".  One of the other authors is a Senior Director of Research at ExpressScripts. That paper details reasons that some groups gave for not wanting to use generic drugs as well as the ways socio-economic status affected purchasing behaviour.

In both Canada and the US generic drugs are required to have a bioequivalence of between 80% to 125% of the brand name "innovator" product. Bioequivalence means that the rate and extent of absorption of the generic drug will produce the same therapeutic effect as the brand name drug. That seems like a lot of flexibility to me.

In Canada we have seen recalls lately on 2 types birth control pills and it has been unclear where either was manufactured. It is not necessary for the drug company to disclose that information.

It should not take years of patient complaints to make a difference as it did with generic Wellbutrin.

I do not yet know about the situation in Canada but I was dismayed to find that in the USA generic drug companies do not share the same level of responsibility as the brand name manufacturer and do not have to update their labels when new risks emerge. In fact the Supreme Court in ruling in 2011 says the rules are different for generic drug manufacturers. 

                                 Justice Sotomayor. WikimediaCommons

Justice Sonia Sotomayor dissented saying that "These divergent liability rules threaten to reduce the consumer demand for generics... Nothing in the court's opinion convinces me that, in enacting the requirement that generic labels match their corresponding brand name labels, Congress intended these results" (Quote from CNN story in link)

I'm not arguing against all generic drugs. The money required to use brand name drugs all of the time would be astronomical. My worry is that patients are not treated fairly in the 'Save Money, Use Generics' equation and that there are exceptions to every general rule.

We need to do four things:
1. Mandate better equivalency and quality testing on generics.

2. Make generic drug makers responsible for harm done to consumers, in the same way as with brand name drugs (see below).

3. Actually inspect factories where drugs are manufactured for use in our countries.

4. Have an effective appeals process for patients who can't tolerate generics for reasons such as allergies to non medical ingredients called fillers.

The next post will have stories of how this situation affects some real patients.

graphic by dmckinnon ©