Brand vs. Generic

I went to the dermatologist a few weeks ago and had an interesting situation arise when taking my prescriptions to the pharmacy.

The pharmacist had prepared the generic (actually, without consulting me, but when she told me it was $30 vs. $100, I assented) but then discovered that the doctor had written some code for "brand only" on the prescription (it was for a cream). She then got on the phone with the doctor's office, and asked them if it was ok to switch. They said yes, but it left me feeling uneasy. I called them later that day so I could hear for myself why the doctor had wanted me to stick with brand. I spoke with the office manager who said that the brand "works better" and that the doctor generally prefers it to generic with all prescriptions. But because the price discrepancy was so great, it was ok to go with the generic.

I've had a debate with M about this before, and after some research, discovered he was right - that generic is virtually the same as brand in almost all circumstances. They have the same active ingredients, but different inactive ingredients.

Which leads me to the question - could the doctor be right, and the inactive ingredients make the drug not as potent? Is it worth it to spend more for the brand? (My insurance only covers generic, so I'll always have to pay full-price) Or does she have some underlying reason for her preference - a kickback from the pharmaceutical company?


Anonymous said...

Once upon a time, I was seeing a shrink while on the generic for prozac. She didn't prescribe it - my primary care doc did. She suggested I get the brand name. When I spoke to the pharmacist about it, she pointed out that both the brandname and the generic that they stocked came from the same manufacturing lab and wouldn't be worth the $50 co-pay v. the $10 co-pay. My point is that the shrink suggested the brand-name but didn't prescribe it...which means no chance of a kickback. Make of that what you will.

Sunflowers said...

Prozac is one of those drugs for which I would hesitate taking the generic. Did you ever switch to the brand? If you did, notice a difference?

I wouldn't take generic for anything serious... but skin cream? My skin is sensitive, so I suppose I could have some reaction to the inactive ingredients... but it seems really unlikely to me that it would "work better" just in general.

BUT, the doctor knows best, right? (If she doesn't get a kickback...) I'm assuming she's relying on feedback from her patients.

I read that pharmacies like the generic because they get "better mark-up." So it's all about money to them... I wonder how much they earn vs. how much we save over the brand?

DogAteMyFinances said...

In Texas at least, the kickback would be illegal. But the drug reps bring other perks like samples and lunch and pens and such.

Bayjb said...

I only buy one brand name drug because I have to but I get a decent deal on it for my health insurance. Right now though, my dermatologist is having some issues with my insurance too, but in a not so good way

Miss M said...

I could see how the inactive ingredients in a skin cream could make the experience different, depending on what moisturizers etc they use in the product. But for medications you ingest the active ingredient is exactly the same and I don't think the fillers/binders would do anything. Unless your medicine is coming from china and then who knows....

Sunflowers said...

In the research I did (so I could debate my bf whenever we had the argument :p), I think heart medication was the only one mentioned as potentially having differences between brand/generic.

I still don't see how the inactive ingredients in the generic skin cream could make it not work as well. Maybe give me some kind of allergic reaction, sure. But not work as well? No.

Then again, I was reading a pharmacist's article the other day wherein he doubted the quality control of generic drugs.

I wish I knew for sure! Apparently the markup is better on generic drugs, so that's why pharmacies push them on you. That annoys me! And also makes it difficult to rely on their opinion that generic and brand are the same. Of course they'll say that, in order to turn a better profit.

Mentally Sane said...

I don't really know about the difference in generic versus brand name when it comes to medications. I've always taken the generic and it's had the intended affect without issue. All of my doctors have recommended generic because they are cheaper. But, in your case, I'd have been upset at the fact the pharmacist didn't consult you first. That's taking liberty, and while s/he had your best interests at heart, they don't know the reasons that doctors prescribe the brand name...perhaps you had an allergy to something in the generic. That's just a pet peeve of mine, they should discuss it with you first.


Meg said...

In my experience, pharmacists often know better than docs when it comes to drugs -- and they seem a lot less influenced by all the marketing. But that's just in my experience.

Also, take into account that with the salaries that some of these docs are making, that difference in price might not seem so bad to them. I swear, if I have another doc tell me, "It's only $$$..." Grrrrrr...

Kiloko Designs said...

(i realize i'm commenting on old posts, sorry. i just wanted to give you my $.02)

my endo usually gives generics when possible, but "makes" me take Synthroid and doesn't recommend a generic. the reason being that the potency of tablets in a single bottle can vary greatly. and thyroid meds need to be regulated VERY closly. i don't argue. it's my health and i end up paying $3 more a month.

anywho...the argument about active/inactive ingredients: i suppose it'll be trial and error for you. maybe the synergistic effect of all the ingredients in the generic won't help you. maybe not. if you have concerns about your doctor being more interested in kickbacks than your health, you should find another doc.

good luck!

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