Sunday, October 10, 2010

The Generic-Go-Round

I'm still surprised by how often customers don't understand what 'generic' means. The ones that do understand are the 'prescription pros' whose eyes actually light up when you tell them their medication is now available as a generic, because they anticipate the price coming down. But many people still look very skeptically at you and ask, "But it's the same thing, right?" I feel as though they think I'm trying to put something over on them.

I've tried out a few different ways of explaining 'generic.' Some of them are:

1. It's the same active ingredient as the brand name drug, it just looks different and is made by a different company. (This one doesn't go over that well. It sounds kind of fishy.)

2. It's exactly the same medication as Zocor, they just can't call it Zocor because that's a
protected trade name. (Sometimes this is met with a nod of understanding.)

3. You know when you buy Del Monte Canned Pears and right next to it on the shelf there is a can of "Great Value" Canned Pears? They're both canned pears. One just has a fancier label. (This one is only used when I'm hitting rock bottom.)

People get funny ideas about generics. We all have the customer who swears, "the generic doesn't work for me," (even though there is no earthly reason why it shouldn't) or "I'm allergic to the generic." I don't dismiss these people out of hand. Generic products can contain different inactive ingredients (colors, flavors, fillers) that theoretically someone could have an allergy to. The lack of effectiveness is a little harder to buy, although again, theoretically a person could absorb the generic product somewhat differently which might affect its action. I recently had a customer beg me for a few tablets of Cardura because since he was switched to the generic, "I can't pee." ( I gave him a few and started the prior auth. procedure -- he did look really uncomfortable).

Other times I think people get it in their head that the generic is not going to work and then proceed to enable that very thing by sheer willpower. I took a call from an exasperated nurse who needed to start a prior auth for Duac Gel because the patient would not use its two --- cheaper---- components separately (Clindamycin gel and Benzoyl Peroxide gel) because she claimed that did NOT work. I'd have a tough time with that. I'm glad to see that occasionally docs will refuse to do prior auths for some of this stuff.

Then there's the flip side of the coin, when someone is presented with a higher-than-expected copay for what is a very pricey brand name drug, and their first question is "Isn't there a GENERIC??" I have to answer, "No, not for this one."

And I get that skeptical look, AGAIN............


Phathead said...

I literally last night went off on a friend of mine after something she posted on Facebook.

She's a first year student and a couple of her professors are... out there. There was a discussion going on my profile about a theoretical patient therapy management and she chimed in, in a semi-joking matter, "Well that's ok, according to the FDA not all generics are the same as the name brand anyway, so you can't go off of that."

Needless to say I made her take that down and calmly explained to her that you cannot put words like that in a public forum with non-pharmacy people. All you do is undermine the profession and hurt our ability to adequately manage our patients.

She was talking about Synthroid and the problems the generics had in attaining true AB-rating, along with some other minor instances.

Hell, I'm still pissed off she said that even just writing about it.

Grumpy, M.D. said...

I always prescribe generics when I have the option.

Pharmgirl said...

I like it when they see the generic name on the literature and argue with me that since there is a generic name, there must be a generic.

Liz said...

I'm a pharmacist, and I generally agree with the above statement. However, my mom has a few dye allergies (Yellow #6, most notably) and inactive ingredient allergies (benzalkonium chloride - which is in all of the allergy eye drops and nasal sprays, last I checked), which makes things difficult for her. For example, she's on brand-name Parcopa - not because the generic doesn't work or she needs an ODT tablet. The other brands/generics in the strengths she needs have the dyes she can't take.

I have some patients who insist on brand-name Celexa, Paxil CR, Effexor, etc. I fully believe that placebo effect has a lot to do with those - specifically since they're mood medicines. I also have a patient who insisted that she needed a different generic brand when we got a new manufacturer in stock for a blood pressure medicine.

Anonymous said...

Hey I have a Parcopa patient that has to take it because of the dye too!

Anyway, I had a patient come in and tell me that their Lansoprazole was not working as well as their Prevacid, they want brand name. I tried to explain to her that they were the same thing. She gave me a big argument about brand vs generic in the synthroid, and this was the same type of issue.

I then pulled out each bottle, made her agree that one bottle was the brand name, one was the generic, I then opened them and showed her that they truly were the same thing.

For those that do not work retail, the generic is actually the brand name in a different bottle, hell the capsule actually says "Prevacid" on it.

Geez, some people

Anonymous said...

I like this story. When I was an intern, Lilly just came out with the generic fluoxetine manufactured by Dista. I was filling a stat refill on script for Prozac 20 mg when the patient told me to take out all the capsules with Dista on them, since only the ones with Lilly helped her, like yeah, man, they came out of the same bottle, but there's a special dye in the word Lilly on the pill.

Sarah G said...

My mother apparently cannot take the generic form of her antacid. Must be the dyes or something (hadn't thought of that), but she really can't take the generic. They're not 100% the same.

Anonymous said...

I have been on sertraline for several years and the first generic I was on worked great. Last year I moved across country for grad school and the pharmacy I switched to had a different brand of generic that did not work at all for me. I had no idea that the generics would be different, I had assumed that all generics were the same.

I went to another pharmacy and they had another brand, still different from the first, but luckily this one works because I still don’t know the name of the first brand.

The Redheaded Pharmacist said...

People just want to know they are getting the drug that they are supposed to get according to their doctor's order. I've had discussions with people that were getting the new Lovenox and Epi-Pen generics and I can understand their concern. These kinds of issues are exactly why pharmacists are so important. We have a chance to educate the general public.

Anonymous said...

I do prefer generics when available. The pharmacy I go to carries one specific generic by default for a medication I receive. I believe there are something like at least five different generics for it. I get a stomach ache from their default generic but they do order me a different generic. I have been going to the same pharmacy for four or five years now so they know me well. I am not a pharmacist or doctor, just a patient.