Brand vs. Generic, Take 2

I thought I would do a follow-up to this post based on a few new comments I received.

When do I think it's worth it to buy brand?

  • Heart medication
  • Thyroid medication
  • Anti-depressants
  • Anything I would depend on to keep my organs functioning!
  • Inactive ingredients are different (can be allergic to dyes/fillers)
  • Bioavailability of active ingredient can be plus or minus 20%
  • Could be manufactured in a 3rd world country (quality control issues)
  • Small changes in absorption can make drugs with a narrow therapeutic range ineffective

Although in some cases I would prefer the generic, I think pharmacists should never push for it. It should be up to the consumer to decide. I know that pharmacies make more money off of the generic (the drug companies offer rebates up to 60% of the drug's cost), and that biases the opinion of the people who work there (pressure from upper management).

I would always trust my doctor's opinion over the pharmacist's. Pharmacists often seem overworked, unfriendly, and like I stated above, apt to make choices for you based on what's best for the pharmacy.

Also, despite my offhand wondering if the reason my doctor preferred brand was because she was receiving kickbacks, I LOVE her and think she's the best I've ever seen (and that's just after one visit). I'm sure she's interested in my health, but since she is a dermatologist, we're not talking about life and death issues here. So even if she did receive kickbacks/excessive perks (which is highly unlikely), I would still continue going to her.

I was just very curious because my natural inclination is to prefer brand, but after researching the subject, I've had to admit that generic is (usually) a fine, and smart (because of the savings), substitute. It was puzzling to find a doctor who preferred brand for something like skin cream.

I'll have to ask the her the next time I see her why she prefers brand. Maybe she'll be able to offer some insight.

Pharmacists' Individual and Organizational Views on Generic Medication
Pharmacies Receiving Massive Rebates from Generic Drug-Makers
Are Generic Medications the Same as Branded Counterparts?
Brand-Name Medications vs. Generic Drugs: The Differences Are Real (it's too bad the author starts the article off so unprofessionally. There's some good info here)
Generic Drugs: Cheaper, Yes; Same Quality, Maybe Not
Generic Drugs Not Always Equivalent to Name Brands


Miss M said...

In one of the articles the lady questions how a $5 medication could possibly be as good as the $50 version. Well there are big reasons generics are cheaper, no R&D costs and no marketing costs. They don't develop new drugs, only manufacture ones already on the market. If you listen to the drug company's claims, R&D costs are the number one reason their drugs are so expensive. No R&D alone knocks off 80% of the price. Then look at how much they spend on marketing every year, billions upon billions of dollars. Generics have pretty much zero marketing. Much lower overhead explains most of the price difference.

Doesn't your insurance push generics more than your pharmacist, I've seen them use brand name deductibles to exhorbitant co-pays to make you, the patient, chose generic. I don't think my pharmacist cares one bit.

Sunflowers said...

Yeah, lack of marketing is definitely why (or one of the reasons why) the price is cheaper. I know at least one of the articles expressly stated that. I think it's a gut reaction in a lot of people (that high price must = quality)... and it's true in many cases. But it doesn't really apply here.

As for my assertion that pharmacists push generics, I'm speaking from the experiences I've had with the pharmacy (where they gave me generics without asking, and I've also had a pharm tech actually argue with me when I said I wanted the brand), and experiences my grandmother has had with MANY different pharmacies, with many different (important, i.e. thyroid) medications (where again the pharmacists gave her generic without asking, even though her insurance covered brand). The pharmacist should be required to ask right up front "do you want generic or brand?" without trying to pressure the patient to choose one or another. Why would their be the pressure if they weren't aware that the generics made more money for the pharmacy?

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