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Is Generic Medicine as Good as Brand Name?

by Matthew N. Parker, M.D.

FDA generic drugs

What They Don’t Tell You About Generics

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 generics as ideal budget savers. Are they as good 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.

How Generic Medicine Is Made

FDA generic drugsThe 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-brand drug 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.

In fact, generic medications are only required to be 80- to 125-percent as effective as the original.

Generic Medicines You Should Question

Because of the effectiveness 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.

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:

  • Anti-seizure medications such as carbamazepine (Tegretol) and phenytoin (Dilantin)
  • Heart medicines like digoxin (Lanoxin) and procainamide (Procanbid, Pronestyl)
  • Levothyroxine (Levoxyl, Synthroid), a thyroid hormone
  • Theophylline (Theo-Dur), for lung diseases
  • Warfarin (Coumadin), a blood thinner

Many 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 Medcare Part D plan each year, he suggests, “look at the different plans and see how they treat brand drugs.”

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Why Generic Medicine Is 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, AZ. “Remember, too, that a patient’s health may be severely affected by high-cost 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, AL.

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Last updated and/or approved: May 2012.
Original article appeared in May/June 2009 former print magazine. Bio current as of that issue. This general health-care information is not meant as individual advice. Please see our disclaimer.

Comments (1)add comment
Very Nice
written by Lumosity Review , May 21, 2009

This is a darn good story. Definitely bookmarking this one.
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