a pharmacist at work behind the counter of a pharmacy

Most (but not all) pharmacists routinely tell patients that generic drugs are identical to brand name medications. That is hardly surprising. This is what pharmacy students are told during their education process. It is also what the FDA states on its website:

“A generic drug is identical–or bioequivalent–to a brand name drug in dosage form, safety, strength, route of administration, quality, performance characteristics and intended use. Although generic drugs are chemically identical to their branded counterparts, they are typically sold at substantial discounts from the branded price.”

What Does “Identical” Really Mean?

Now we don’t know about you, but when we see the word identical we assume that means exactly the same as. Here is how Dictionary.com defines the word identical:

1. Similar or alike in every way
2. being the very same
3. agreeing exactly
Related Words for: identical
Indistinguishable, one and the same, selfsame
Medical Dictionary
1. Exactly equal and alike
2. Of or relating to a twin or twins developed from the same fertilized ovum and having the same genetic makeup and closely similar appearance; monozygotic.

In our opinion, the FDA’s use of the word identical, when describing generic drugs, is misleading. First, the inactive ingredients (colors, binders, fillers, etc) do not have to be “alike in every way” to the brand name product. In fact, they are often quite different. These so-called inactive ingredients or “excipients” may influence how the product affects patients. For example, a patient who is allergic to a particular color may develop a rash when switched to a generic product.
The formulation may also differ dramatically from the brand name. Many pharmacists may be unaware that the physical characteristics or release properties of a brand name drug often stay under patent even after the active ingredient becomes available generically. This is especially problematic for slow-release or long-acting medications. Generic manufacturers may have to come up with different technologies to deliver the active ingredients. This means that the products are not always “indistinguishable or one and the same.”
To see this for yourself, visit the FDA’s website and report on the antidepressant bupropion XL.
If you look at the graph the FDA provides you will discover that the mean plasma concentration of the two drugs is certainly NOT identical! The generic formulation (which uses a matrix technology to release the active ingredients) produced peak blood levels in 1.5 to 2.5 hours, whereas the brand name product (using a membrane technology) produced peak blood levels around 5 hours. This kind of information for other generic formulations is not always easy to access.

Manufacturing Quality of Imported Generic Drugs Remain

Here is something else a pharmacist might not realize. According to the FDA, 80 percent of the active and inactive ingredients in our pharmaceuticals come from abroad. It is estimated that 40 percent of the finished pills come from abroad including countries such as India, China, Brazil and Mexico. It is also very clear that the FDA does not have the resources to inspect all or even many of the manufacturing plants producing either the raw materials or finished products millions of Americans take every day. That means that there is no verification system that the pills are exactly what they say they are.
We have seen manufacturing problems with some of the most prestigious drug companies in the U.S. (Johnson & Johnson and GSK). These problems occurred at plants where the FDA visits on a regular basis. Do we really believe that chemical companies in China that are not inspected are producing perfectly identical generic drugs at cutthroat prices?
Perhaps it is time for pharmacists to acknowledge that there are no guarantees when it comes to generic drugs. Pharmacists must be the patients’ allies and advocates. When patients experience problems with certain generic formulations, pharmacists should offer a sympathetic ear and report the problems directly to the FDA’s website (MedWatch). Perhaps if pharmacists insisted that the FDA do a better job both approving and monitoring generic drugs, patients would have more confidence in these money-saving pills.

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  1. irene
    new jersey

    maybe if our politicians took generic drugs they would have a different attitude

  2. Eleanor
    Bellevue, WA

    I am confused about heart & blood pressure medication that I have to take. Lisinopril causes me to cough, which is terrible and keeps me awake at night.
    Now I am taking Losartan which also makes me cough terribly. Is there no other blood pressure medication that does not cause a dry cough? My doctor told me I have to take the Losartan. I am certain they are all generic drugs, is there something in these drugs that cause this awful cough?

  3. Troy

    I have severe reactions to generic drugs. It varies per prescription for me:
    1) Seroquel vs. Quetiapine: The brand name puts me to sleep; the generic brand does not put me to sleep.
    2) Neurontin vs. Gabapentin: The brand name eases neuropathic pain; Gabapentin eases pain but puts me in ER room.
    3) Benicar vs. Losartan: Benicar eases hypertension;the generic creates headaches which cause more tension.

  4. Corinne
    Los Angeles

    When I am put on a particular medication– brand or generic– and I STAY on that medication, I’m fine. I decided to start asking for brand name meds only because I am fortunate to have good insurance that makes it affordable for me to obtain brand name medications. I did not want to deal with the switching of generics, as this had happened before and in each case, the side effects/withdrawal, etc. were too much for me to handle.

    Much to my dismay, one of the brand name drugs I was on stopped being manufactured for 6 months. I was given the Teva generic. I had been on Teva before and it was okay. However, I knew it was weaker than the brand and asked my dose to be upped to account for the differences in potency that my body experienced. My psychiatrist treated me with very little compassion. Citing statistics that 99% of people have no problem with generics. I eventually adapted to Teva, but it threw my body out of whack for a few months. When they started making the brand name 6 months later, my body had a reaction. I said, “let me just stick with Teva.”

    Just a month ago, I was given a new generic after taking the same one for 6 years. After a day, I began getting headaches and feeling dizzy. Battling flu-like symptoms and digestive issues. The pharmacist was so cavalier. Generics are 95% similar, he told me. He said that generic I was on was back-ordered for 6 months. I asked, “Why?” He said, “I don’t know, sometimes somebody doesn’t come into work for 3 days in a row and it throws the whole production schedule off”. I’m pretty sure he was mocking me.

    I can’t speak for those who are on drugs for blood pressure, cholesterol, diabetes, and so on and so forth…..but I know that for me, having mental health issues, the generic/brand issue and all of the switching back and forth really messes my body up. I know I have sensitivity issues. I realize I may be part of that 10% or that 1% that reacts to different filler ingredients. Nonetheless, this in itself is not a reason to ignore the differences in how these medications are manufactured. Somebody should be able to take either formulation and know with confidence that they will get the same result.

    • Klon
      United States

      I believe you may be talking about Klonopin.

      I had been on it for a Decade until they/Roche stopped making it and farmed it out to Genentech years ago. Production was interrupted at that time too. but it resumed the same.
      In the short interim (search drug name an ‘shortage’) I was forced on a generic that wasn’t remotely the same.
      Totally ineffective but short lived.
      So ineffective I had to use Valium instead.

      But the more recent stoppage lasted from March to November of 2014 and then Genentech/Roche resumed production of an obviously Very different; virtually No effect whatsoever.
      I understand now made in Mexico.
      The generics are rated on many sites, Mylan the worst on all.
      Search ‘Mylan Klonopin’ problems.
      Many had withdrawal symptoms from these generics, and at least one claimed seizures for that reason.
      I ended up on Teva as at least it had some effect, if Not remotely the same overall relaxation of the original Roche.
      The New “Brand Name” Genentech/’K-Cut’/Roche Klonopin is just another Generic now with even Less effect than some of the others.
      You simply can’t move production and ingredients around the planet for cost sake and not expect vastly different results.

      It’s not until you take a drug that you Feel that you ‘get it’.
      You don’t know if/that Cipro you’re taking is crap, but it very well may be.

      How do you think that Mexican Dom Perignon would be, made with the ‘same’ grapes’, ‘same oak barrels’, aged in in the ‘same conditions and time’?
      Chemical bonds are tricky, and as the author says oft made with unknown ingredients by people who no doubt alosomake Fake drugs in their spare factory time in China, India, and Mexico. (as 80% of bogus generic is)

    • sherry
      Sonora, CA

      Corinne in LA, I think it is much higher then 1 to 10%. I hear everyday of someone who is very unhappy with generic. I have a sensitive system too, and if we were used as drug testers that would not be a bad or negative thing. We could predict what a vast amount of people would have to deal with . It is however a bad thing for us personally because we keep being told what we feel is impossible. We keep getting labeled and treated as neurotic, crazy (yes I have been told that is crazy), stupid, and the worst of all; laughed at by the doctor and the pharmacist. One time, I had a pharmacist sit down next to me and apologize for what I was going through. He said he did not understand why the brand I had been on for a while and could purchase for just 10 dollars was not being prescribed. When I was just at the doctors office he shook his head yes and said OK I will write brand, but he ordered what he wanted the generic so I called and told the office he has made a mistake and they said it was fixed and after 3 visits to the pharmacy, an hour round trip it was not fixed . finally the pharmacist told me the doctor called and he won’t switch to brand with out you paying for and scheduling another visit. I was shocked , why did the office tell me it was fixed. He told me the doctor said now that it would be changing meds and I would have to see him to change it. I never got any meds I yelled . I have constant night mares because some generic make me vomit and sick only to be told I must have had the flu.. The insurance will do everything they can to make you give up . But for me I would rather drop dead then take something that does nothing or worse makes me sicker. . What is the point. I know so many, and over the years I see the numbers growing of people and doctors who are unable to take generic. More people need to stand up and there needs to be a place where people can file complaints that are counted. I am getting to a place where now my insurance will be too high a price and I will be with out meds. I am 61 and don’t expect to be getting a lot better anytime soon. I am dreading having to suffer with depression and pain and insomnia . But generics make me sick, really sick so I will not have a choice. When faced with projectile vomiting I guess I will just go with the suffering. I hope it changes for the better soon and you know there is may be nothing wrong with you and you may not even have a super sensitive system. It just might be the generics.

      • Kris

        I have a very sensitive system. I have multiple medical problems but interstial cystitis & fibromyalgia are the worst. About 75 % of foods & drugs are irritants to my bladder and can throw me into a tailspin of pain and misery. Generic pain meds don’t work and make me nauseated and generally feel worse. I had to throw them out after two weeks. The price is exorbitant for brand. But at 63, I doubt I’m going to improve. I can’t envision making us go broke trying to pay for brand names. I just got script that was $1000 for 60 tablets for pain med for one month. Considering I have 6 other scripts, it’s unsustainable.

  5. Dawn
    Los Angeles, ca

    I had to pay for two of my prescriptions because the generics do not work for me. They are very expensive. It’s so sad that most people believe that generics are “identical” and if the generic isn’t working, they probably think they are getting sicker or something else is wrong with them. Generics should be mandated that they really do have to be identical but the FDA doesn’t care!!

  6. vic

    what company in the US makes generics.

  7. Naomi

    I was in a car accident(Sept 2014) that caused a brain bleed, that resulted in a hemorrhagic stroke, I had to relearn how to walk and talk again.

    As, a result of brain damage from my stroke I have seizures. It is very important that I take medicine that works. I’ve gone through several generics and NONE worked for me. I took generic Keppra, I broke out in a rash, then my neurologist played around with the dosage of oxcarbazepine generic (Trileptal)

    While on oxcarbazepine I broke out in sores on my forehead that wont heal, I could not increase the dosage pass 150mg otherwise I could not pee, it literally stopped my urine flow. I had two break through seizures a month a part while I was taking generic oxcarbazepine.

    Now my neurologist write on the prescription (DAW) dispense as written, it now cost me $188 for brand Trileptal and $261 for brand TopAMAX that is the price for the American way if you want to stay alive.

  8. Nick

    This article is unbelievably fallacious and biased…in both tone and content. I don’t understand how any rationally-minded person could take this seriously. Regardless…

    If you truly are concerned about the bioequivalency of a generic of a medication, discuss it with your prescriber. Everyone is different in the way they metabolize any medication, much less generics, of which there are many different manufacturers. The point of producing generics is to help the patient population in having access to and affording medications they truly need.

    For example: a patient that I regularly serve at my pharmacy was not pleased with the effect of tramadol, a generic for the medication Ultram. She is a chronic patient of tramadol- she receives 270 tablets per month and has been for years. Her insurance covers the entire 270 tablets of the generic for a $0 copay. Her insurance covers 270 tablets of the brand name Ultram for a $100 copay.

    Bottom line: She discussed the issue with the generic medication with her prescriber, and got a prescription for the brand name medication. As a pharmacy staff, our job is to provide FDA-validated information to help our patients, not have a crutch to swing at patients when discussing brand name vs generic drugs.

    • The People's Pharmacy


      As a pharmacist you are in the trenches every day dealing with generic drug issues. You have been told that the FDA knows what it is doing when it comes to approving and monitoring generic drugs. Have you ever actually seen a bioequivalence curve? Except for the antidepressant Budeprion XL 150, we have not seen any bioequivalence curves released by the FDA. The agency says in essence, trust us, we know what we are doing, but you can’t see the data upon which we base our decisions because it is proprietary.

      Nick, you would not accept that kind of response from car manufacturers or the makers of other critical products. Why accept it from the FDA? All health professionals (physicians, pharmacists, nurses, etc) and patients should be able to actually verify that generic drugs are bioequivalent to brand name products by seeing the data and the bioequivalence curves for themselves. Without that, you are taking the FDA’s word it knows what it is doing. The agency didn’t when it came to Budeprion XL 300.

      You also assume that the agency is monitoring manufacturers in India, China, Thailand, Brazil, Slovakia and other countries. Reports from India over the last few years suggest that there is an unreasonable amount of fraud and that many generic drugs have not been of the quality expected by Americans. That is why so many generic drugs have been banned from this country.

      Yes, we all need affordable drugs, but we also need transparency so we can look at the data to verify that the products truly are bioequivalent and we need better monitoring of drug companies abroad…in our opinion.

  9. William

    Is a pharmacy permitted to refund you your paper prescription for Adderall so you can try a different drug store to get the brand of generic which works well for you, but which was not in stock at the time you needed to fill your prescription?

    • Ann

      There are no refunds and no ‘do-over’s on prescriptions, especially on a controlled substance like Adderall! You have to drive around to one pharmacy after another (since most won’t discuss availability of controlled substances over the phone), as long as it takes, until you find one that has your preferred brand in stock. Once you fill, that fill is gone.

  10. Bruce

    An adverse reaction to any medication, brand or generic should be reported to the manufacturer. The generic market has changed over several years as around 50% of the generic manufacturers are now owned by a major brand name manufacturer.

    One of the concerns expressed today has to do with obtaining raw materials. More and more raw materials are coming from outside of the US. How well are the raw materials being screened or tested? Shortages in raw materials have caused back-orders in the final products.

    In recent years it was stated that most of the plants making generic products were more modern than the older brand name plants. More than one study has shown that the actual variance in generic vs brand is only about 4%. Of course there are exceptions especially in those products that are delay release or time release in nature. Though the active ingredients are shown to be the same other non-active ingredients being used in make up of the product can vary. Adverse reactions can be shown to be caused by dyes and fillers.

    Stabilizing a patient on a medication whether it is generic or brand should be of great importance especially in those medications that require monitoring with lab tests. If there is a problem report it to the manufacturer and your pharmacist should be able to tell you which manufacturer’s generic is being used.

    In over 40 years in this profession I have seen a lot of changes however profit was not the most important motive. Getting to know and talking with patients about their own personal situations has always been of utmost importance. Also important was seeing that patients could obtain and properly use their medications.

    In my experience these two situations are starting to disappear in pharmacy today. Profit and volume have taken the place of patient care. Too many times patients are being told that their insurance will not pay for a medication and they are not given any suggestions or options-just pay for it or go without. The pressure today is placed on the patient to resolve the problem like “talk to your doctor” as if he is going to know what formulary options or restriction overrides may be available. I know because I do not dispense medications anymore. I instead work with patients on a daily basis as an advocate in dealing with these and other issues.

  11. Michelle
    United States

    The CVS Pharmacist by my house treated me like I was an idiot when I asked what brand they could get. Of course he also threatened to report me for getting prescriptions from my PCP and my specialist because he stated it was illegal to get different prescriptions from two different doctors. Go back to school is what I say!

  12. Susana

    My son was recently diagnosed with epilepsy and was put on Keppra XR. I had to ask the doctor to please allow him to take the generic, otherwise I have to pay almost $400 for a month’s supply. This is something he will be taking for a LONG time and I can’t afford the brand name. I just keep my fingers crossed that the generic will do the job. Thanks pharmaceutical companies for making your brand name prescriptions so expensive that the average middle class family can’t afford them.

  13. Stacy

    I want to ask why my pharmacy continues to change my prescriptions. With mental problems this is a problem. I get one generic (Sandoz) for 6months and they change to another.
    The first generic is long lasting with a hard coating on it. The 7th month, they give me the generic from ( Mallinckrodt ph ). This generic does not have any coating, and looks like they were homemade. I took them for 5 days and returned them to pharmacy, they told me Sandoz was on back order, so I finished out the 30 days. I was a horrible person to my children by screaming and crying all day every day. I could not function. The next two months I got the Sandoz. Now they have told me they are on back order and cannot get the Sandoz generic. I refuse to take the other generic, I will be depressed and suicidal with or without the low budget generic, which I have no idea where it comes from. It is obvious to me and should be to them that it is not made in a safe environment.

  14. Lyn

    I am on Norvasc for Blood Pressure and have been for over 20 years. I had trouble finding a product that worked for me without side effects and I will continue to use it. My concern here, is when I put a prescription in to be filled at the pharmacy, I am often given the generic brand, WITHOUT prior consultation. I always refuse it and they have to give me the one on the prescription. They will get away with it if they can. I am told it is their “policy” not to ask anymore. Well, excuse me! This is something I am putting in my body and I therefore deserve to be given the choice. I wonder WHY they don’t ask. I do know of a few who do ask and in the future I will be shopping at those pharmacies instead. Generic is NOT an identical product. Identical drug maybe, but not identical recipe.

    • Pharmacy Tech

      Well, I work in a pharmacy. When the doctor writes out the prescription, they will state whether or not the generic may be substituted (its a dispensing DAW code). In your case, I am assuming that the doctor did allow it. Most cases, the doctor will put a DAW 0, meaning that the drug may be substituted with the generic.

      If you wish to only receive the brand, let your doctor know and they can specifically write that the patient requests the brand. A pharmacy can only fill what the doctor allows, but at the same time, they want to help you save money. So, most times the generic will be switched out IF the doctor approves. Also, I would let your pharmacy know that you do not wish to get the generic. They would be more than happy to give you what you want. They can even leave a note in your profile for the future, so this does not keep happening.

    • Brad

      The bonus is on the patient to ask for the brand name product. Over 99% of patients respond well to generics and it saves them money as well. Hence, they are given the generic without consultation.

    • Lauren

      Your doctor has to write “DAW” or “dispense as written” on the prescription to dispense the brand name. Otherwise the pharmacy will dispense a generic.

  15. David

    I have done so much research, but I don’t have time to put it all in. FACT: SFDA leader in China was publicly BEHEADED because he took bribes allowing factories that did not even meet standards to manufacture. The CEO of their 3rd largest pharmaceutical company was later found to do the same thing but because of bad publicity, China commuted his sentence to life.

    Some of the worst problems are with mass produced old timers such as diazepam and phentermine. If they are all the same, why did the FDA come out with a new test for diazepam (their fourth).

    Mylan is a high quality manufacturer but their generic diazepam is THE WORST ON THE MARKET. They are green, fall apart like chalk and do nothing. My doctor has heard nothing but complaints. I had to be approved for brand name Valium since my pharmacy started changing every month. Same with phentermine but I have to get generic, pay for it myself, but I can have my drug store special order from any manufacturer in 24 hours no charge. Reason? The other types cause me rosacea horribly. The one I order does not.
    The FDA on average hits a foreign manufacturing plant once every 9 years, American twice. Companies warned for potential contamination ignore the FDA warnings and it has resulted in many deaths and mass poisonings. They happen in the US a lot and people don’t pay attention.

    Teva brags they try to make better meds than FDA standards. BS. The Welbutrin 300 was a great example. Some manufacturers put plants in Puerto Rico and hire 3rd party QA inspectors who get paid by that company. They seldom respond to citations.

    If you look, you can find hundreds of plants closed that were making phentermine. The plant closes, and they open or use another one. It’s disturbing. I had some twit young pharmacist try to talk down to me over the issue and I reported him to his district manager and she talked to me for over an hour on the phone because she knew nothing about it.

    Different manufacturers may use different fillers that cause you nausea or other symptoms.
    I can’t believe the FDA and the AMA keeps up this facade. But some ridiculous coverage about Red Bull because it gets news coverage all of the sudden garners attention when it’s been tested all over the world (very extensive tests). If people are drinking red bull in their alcoholic drinks hospitals would still list it. Red Bull (small can) has less caffeine than a cup of coffee. It has taurine which helps prevent certain heart diseases, Inositol which helps with depression.

    Meanwhile the FDA shoves out drugs in high dosages like Serzone and Cymbalta that caused liver failure and death because they did not test enough nor start out moderately. I could go on but don’t have time.

  16. BL

    “IDENTICAL” is a correct word, but it is true that we have to be very careful about patients being allergic to the non-active ingredients, as they may be the one causing the problem.

    So if you are comfortable taking generics, go for it, as it will not do any harm to you.
    But if you are allergic to, or have history of being allergic to particular agents in the product, you must stick with what you take.

    P.S. Panadeine forte in Australia is made in India where its generics are also made in, such as Comfarol Forte or Paracetamol/Codeine GH tablets. So talking about the country where the drugs are manufactured in would lose some persuasion in this context.

  17. a l

    My insurance has referred to chemically different antibiotics as “generics” – in other words, an older drug which is used for the same infection, which is NOT the same drug. How can they do this? That’s like calling aspirin a generic for ibuprofen.

  18. JW

    It is true with the drug Dilantin, my doctor requires I only take the brand name. He wrote a letter to my insurance company to have them pay for the band name, but they didn’t approve it. So I have to pay more but it’s worth a piece of mind.
    Dilantin is an old drug but the extended tabs probably all work the same. He even said the generics differ from name to name. If I were to get the generic brand all the time it would be ok. But you get all different names.
    So definitely ask for the brand name from your doctor and insist for the brand name.
    Good Luck, I wish your family the best!

    • J. Berk
      York, PA

      JW… I also “unfortunately” have been taking “brand” name Dilantin for nearly twelve (12) years now. “Expensive”
      My neurologist and I have attempted numerous times over the years to switch me over to the generic. It always ends up in severe seizure. I am extremely thankful this medication exists. However, it is certainly true that not all “generics” are the same as their brand counterparts. Even more alarming is that pharmacies will “often” change manufacturers from which they purchase their generics at any given and many times due to their price. On the surface this may seem fine, but when one truly realizes that not all generics function the same in one’s body and may in fact have up to an 80% leeway. In my opinion, it’s not responsible. I’m fortunate, I guess, that I can often tell of a change in medication. (outwardly ending in a seizure)
      However, just think of how often a pharmacy may change the manufacturer of a “generic” blood pressure, asthma, cholesterol, etc…(the list goes on) medication and that person does not realize any change until it’s too late!
      The solution is simple. An 80% leeway from brand is simply not acceptable. I believe, if attending school or college, a grade of 80% is a C or C-? Is that acceptable?
      Generic medications should function within a 99% tolerance of brand at worse or else not be approved by the FDA. In addition, individual pharmacies should self-impose their own strict testing and compliance along with FDA standards to assist. This only makes sense and creates safety within the industry. Anything less is careless, dangerous and deadly.

  19. MM

    I take Ef….r it is costly. I tried a generic equivalent for two weeks because the pharmacist claimed it was the same, but I felt very different, dizzy, not well; I went back to Ef….r brand. I feel sorry for people who can’t afford the original brand medication. The generic medication should have to go through the very same research protocol as the branded original medication before going to the market, otherwise the patients are the lab-rats of the generic pharmaceuticals company.
    Is there a committee where those who suffered bad effects of a generic medication can send a summary of their case? If several people react poorly using a specific generic product, some changes could be done to improve the generic formula.

    • Kanitau
      el cajon ca

      Insane. Pure insanity. It should be ILLEGAL to prescribe any generic drug to people who have epilepsy. This isn’t like a pain pill, where if it isn’t the correct dosage you will go into a tonic clonic seizure or possibly DIE from hitting your head as you fall on the ground during a DROP seizure. GET A F&^%$% clue people. NO GENERICS for epilepsy!!!!!!!!!!!!!!!!! PERIOD> This is just so lame and idiotic it defies logic. BRAND name ONLY for epilepsy patients. Quit playing games with people’s LIVES you incompetent fools.

  20. MWJ

    I have been on the name brand of Cymbalta for 5 years now. Suddenly, my insurance company has decided that because there is now a generic for Cymbalta that I now have to take it instead.
    I have tried 4 different kinds from different manufacturing companies, and NONE have worked. Only the BRAND Name Cymbalta works on me!
    After months of fighting with my insurance company and with my wonderful Drs help and constantly writing on the Rx for “Brand Name Medically Necessary ,” my insurance company still will not pay for my Cymbalta anymore! I have even had blood work done while on each generic, proving that it wasnt working or even showing in my system!
    That is all….

  21. Cpmt

    Generics from China and India…2. I know I only can use non generic, only brands with some of my meds.

    • David

      Watch your dosage with Cymbalta. It was originally prescribed at high dosages and has been shown to cause liver damage (failure, death). Many pharmacies will not except the maximum dosage doctors were prescribing not realizing that the FDA lowered the max dosage.

      I got my insurance company to put me on Brand Name VALIUM instead of the crappy diazepam they kept giving me. I take a lot of meds so these variances are no small issue.

  22. SallySue

    It is unbelievable the people posting that generics are identical is not misleading. IT IS! Identical is as it says, identical. Not a copy, not close too, but identical. As in many other areas of manufacturing when products come out of the same line, say Air Conditioners, and the only difference is the label at the end, one says Carrier, the other Bryant. Yes, they are identical. This is NOT how non-authorized generics are created. To expect Americans to settle for trickery is what has made millions for those producing inferior products. My stance is if I can’t sue the generic manufacturer for a faulty drug, how stupid am I to take it? If you allowed the slightest accountability for wrong doing, including jail time, we might actually be protected. Instead, you take self reporting from the conflict of interested manufacturer of the medication for face value and do not require independent testing to verify it is correct. Crazy. Why don’t you allow students to grade their own SAT’s while your at it? Same thing. Thank God it’s coming to light that while not all Generics are inferior, the checks and balances is so far off of protecting consumers we should boycott generics until the FDA actually lifts a finger in advance and tests whats already out there, brand too, and whats coming in the future. It is insane that they do not test after the product comes out too.

    • Cheri G.

      Well said. Thank you for summing it up so perfectly!

    • Mike

      You’d crap yourself if you saw the 4 different companies that manufactured the four doses of your IV antibiotic in your hospital– of course, when you don’t see the bottle or drug, you don’t know any different– we can monitor blood levels and do for most serious antibiotics (ie vancomycin) and they are all equivalent. There is something called science, ya know.

  23. ak

    Generic drugs = brand name drugs. Generic drug PRODUCTS are not the same as brand name drug PRODUCTS.
    Drugs are the same. Products are not. Remember that RPhs dispense drug PRODUCTS not drugs. This is how we can say generic DRUGS are identical, but we can’t say drug PRODUCTS are identical. The title of this article should be “…. generic drug products”.

    • David

      The FDA does check after the drug comes out. Usually given to four major companies and tested vigorously. However, it then drops to 2 visits a year, and as for foreign they only manage 1 every 9 years and cannot hit them all.

      If your pharmacy chain wont order a generic that works for you, switch. Some phentermine causes my rosacea. Red nose with a rash around it. I found one that doesn’t do that, I special order from Rite Aid with a 24 hour turn around and no extra expense. When I forget to remind them back comes the red nose and rash.

      This article scratches the surface. Check for the plants that just get shut down after manufacturing inferior meds and another one opens. When people say “My medication doesn’t seem to be working, their could be a very good reason.

  24. RB

    People’s Pharmacy please respond.
    The article argues an important point about the role of pharmacists in advocating for better drug safety reporting and ensuring the best possible treatment for patients. However, the article does not really provide any clear answer on its original point and the point brought up by many of the comments which is “What should a pharmacist say when a patient asks if the generic is ok?”
    My answer is customarily “The active ingredient in this generic is equivalent to the brand name product as per the FDA. There are differences in the inactive ingredients and the effects of these inactive ingredients can vary with each person.” Of course, this has to be varied so that the person getting the medication understands what I am saying, but the gist remains the same.
    If a customer calls to complain about a side effect they developed from a generic that they did not get from the brand, I inform the prescriber and the manufacturer (calling their drug safety department). If the patient is okay with talking to the company directly, I also pass along the patient’s contact information (only after explicitly getting permission from the patient). If the medication is not working, I try my best to find something else for the patient and also start the drug safety report with the company. I consider this an appropriate response. I hope that all pharmacists follow these basic steps and the pharmacists I know do follow these steps because this is what we studied 6 years to do.
    However, the article and following comments miss 2 major points in this discussion:
    1. Incorrect Incentives
    In the current healthcare system, the pharmacist salary is based on prescriptions sold. The legal and ethical expectations placed on pharmacists to counsel, ensure optimal therapy, and be the patient’s advocate is not reimbursed by insurance companies or any other entity to the pharmacy organization. Pharmacies make money almost entirely moving product-just like t-shirts. The amount of time I spend looking into any questions or issues with medicines patients have directly reduce my productivity because in those periods I make the organization $0.00 per hour. Consider the sheer stupidity of that point. I studied in school for 5 years and spent a year working for free to be able to help people make the most of their drug therapy. I am expected to do get people their medications, make sure they use it right, make sure doctors do not write for interacting medications, and watch out for abusers. All that is for not reimbursed. BUT, the insurance company will pay me to be a glorified vending machine.
    2. Patient/Citizen Responsibility
    This applies more to the responses I read after the article. Since all of you are well-informed enough to read people’s pharmacy and motivated enough to reply to this article, have you also filed a report with the manufacturer in question? The companies have entire departments (called Drug Safety, Pharmacovigilance, etc) dedicated to getting your phone calls. Major adverse effects reported are by law required to be processed in within 2 weeks. A quick google search will bring up the company’s corporate phone numbers.
    Also, I read a lot of complaints about foreign manufacturing (which, on a side note, brand manufacturers do as well). Why not write to your Congressman or Senator? Ask them to increase funding for the FDA rather than cutting its budget. Ask them to change the law that requires pharmacies to dispense generic unless specifically instructed by the patient or the doctor. In fact, ask them to stop imports of drugs from out of the country. Congress members will actually listen to you especially if you write a letter or show up at their office.
    As a pharmacist, I try my best to do right by my patients. I come to work every day to help them. If I wanted to cut corners and hurt people to make some more money, I would have become a Wall Street banker. However, I am also subject to the financial pressures of the time. Ordering brand medications and dispensing them at a financial loss is a great way to become unemployed. Generic medications have been a blessing to a lot of people who may not have been able to afford medication 40 years ago. Clearly there is room for improvement at every level of the system. Pegging pharmacists with the job to “tell the FDA” to regulate generics more is not helpful.

  25. RB

    The reason why you have trouble finding brand name medications is because too few people are willing to buy the product like you are. The pharmacy is not going to order a bottle of 100 tablets a brand medication which will likely cost them 10x the cost of the generic medication they have on the shelf only to dispense 7-14 tablets to you and the remainder of the 100 tablets sit on their shelf until it expires and they have to throw it out. It would be a huge financial loss and therefore probably would not be ok in any corporation.

    • Ann

      I had a local pharmacy ordering a brand-name product just for me, in the quantities I needed, that I reliably paid the higher (and ever-increasing) price for due to problems with the generic… until their wholesale distributor decided to stop carrying the brand-name product! Most of the other pharmacies in the area use the same major nationwide distributor. So now, in a mid-sized city, I’m left with only two places (at even higher prices, of course) to buy a non-controlled substance that’s been on the market for decades.

  26. Marte Keller

    Will someone (hopefully People’s Pharmacy) please tell us how to find out where a drug -generic or brand name- is manufactured? There must be some way of getting this information. Remember too that many of us don’t get our medications from a pharmacist rather they are mail order per our insurance’s requirement.

  27. Sheryl

    I was told by my endocrineologist that he wanted me on brand. He said (unless you’re looking for change in your sofa, go with brand) He & his administration have told me (Big Pharma, ins. Co’s & pharmacies make more $$ off generics. He has been head of endocrine for 25 yrs. I do have problems with generics & would like advice on the ones that I am on. Thank You

  28. Lynn M.

    I am taking 3 generics all made by Ranbaxy. I would like to take generics made in the United States like Mylan, which makes all 3 of my generics. My pharmacist says she can not change, how can I gen U.S. made generics?

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