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Why Pharmacists Are Wrong About Generic Drugs

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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."

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.

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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Your article is short sighted and tells only half of the story. In my state of Texas, a drug has to be both pharmaceutically AND therapeutically equivalent. Not all states have both parameters to allow generic equivalent substitution.

I also take personal offense to your presumption that a pharmacist would be unaware of a particular release mechanism and being able to compare the two. That is a first semester pharmaceutics class.

A person is responsible for their own health not the pharmacist. However a pharmacist is the drug expert and I know of none that will put profit over personal safety. I know they are out there but few. However, many patients are held hostage by the insurance company monopoly. If a person wants a brand they ALWAYS has the choice of the brand. But they will need to pay because it's their insurance.

PEOPLE'S PHARMACY RESPONSE:

Anthony, for 25 years we were among the country's most enthusiastic supporters of generic drugs. This was at a time when physicians and pharmacists were somewhat distrustful of generics. Many times we would debate health professionals who insisted that supporting generic drugs was detrimental to new drug development and besides, generic drugs were often inferior. We always sided with the FDA and insisted that generics were "identical" to brand names.

Almost 10 years ago we started hearing from patients who complained that they were having problems with certain generics. At first we denied such a thing could be possible. It's hard to change a position that has been so firmly entrenched for so long. But as the complaints mounted, we could no longer turn a deaf ear.

Then we learned that there had been a tremendous sea change in manufacturing. Instead of "Made in America," most generic drugs were being made overseas. Did you know that the head of the Chinese drug regulatory agency (the equivalent of our FDA) was executed because of fraud several years ago?

Did you know that the Chinese authorities have still not cooperated fully to disclose the true problems behind the heparin disaster that killed dozens of Americans? This was a case of out and out greed. And to this day we still do not know who was responsible. That gives you some idea of cooperation between Chinese and American regulators.

Do you have any easy way to learn what the release formulation is for any long-acting generic medication? If so, we would love to know where you look for that data. Where do you go to find out the pharmacokinetic data for any generic product that you dispense? We would love to see those graphs, so if you can provide them for metoprolol succinate (vs Toprol XL) we want to see them.

Be honest now Anthony. Have you ever heard a complaint from a patient about a generic drug? Have you believed that person or have you chalked the complaint up to a psychosomatic nut case?

We have heard from so many patients that we can no longer discount the complaints. We hope you, like us, were horrified to learn about the manufacturing problems with J&J and GSK. If they could happen to such prominent brand name companies in the U.S., what makes you think that they could not happen to a small generic manufacturer in Mexico, India, China or Brazil that has NEVER been visited by the FDA? Not all generic companies are owned by big brand name manufacturers. And even if they were, that would not give us great comfort if the FDA never inspects the facilities.

You say that in the great state of Texas "a drug has to be both pharmaceutically AND therapeutically equivalent." What organization in Texas verifies that every generic drug meets those standards? Who does the testing? Who does the monitoring? Where can we check on that testing process? And by the way, what organization in Texas tests and monitors OTC pharmaceuticals?

We would never suggest that a pharmacist would ever put profit over personal safety. We are saying that many pharmacists have accepted the FDA's message that generic drugs are "identical." We live in a era of evidence-based medicine. Have you seen the evidence that this is true for all the generics you dispense or are you taking the FDA's word for this? If the latter, then that is not evidence. If the former, tell us where you go to see the bioequivalence graphs for every generic you dispense.

Please visit the Pew Prescription Project website. You may be surprised at what you discover: After Heparin: A Roundtable on Ensuring the Safety of the U.S. Drug Supply. You may be surprised at what you learn here: http://tinyurl.com/6zajlfr

I have gone through your article and anthony's comment, but my objection is that you insisted that has d regulatory agency in Texas verify every generic, if that is the problem then same goes to the branded. Because you have given a classical example of a multinational company like GSK, if we should be so assured of the branded drugs what gives you the impression that every branded is identical to other brands of the same drug from same company since the FDA is unlikely to test every brand from the company... so I believe that in as much as we have more confidence on the branded we should not be absolutely certain and assuring on them either... Abubakar D. ..Nigeria

THEY are absolutely not the same as brand medicines. I absolutely can't take generic (other people do not have problems with generics). And it can be very dangerous taking the wrong thing. Even, company to company generic can change and be different.

Last year I had serious problems with a generic drug for diabetes. Now, after many calls and fighting with the drug co. finally I am taking brand... still have problems but I don't think are as dangerous and with generics. I think there is a law that if the Dr. writes brand only or brand necessary THEY (pharmaceutical co.) must give you the brand medicine.

Thank you for your response to the pharmacist, wow! I have been instructed by my child's neurologist to have the brand name anti seizure drug only (which is time release), have had pharmacist refill without our knowledge to the generic. Have had several discussions about previous refills and to be told very unkindly by the pharmacist, NOPE! After several calls back to the doctor to have them call the pharmacy personally to fill with the brand name. I have switched pharmacies, same store different location where the pharmacist was more than willing to see the previous refills were brand name.

I am a senior and I take generic medications for a heart valve problem and Congestive Heart Failure. Is there any way I can find out if they are as safe as the Brand name and also where the drugs come from? The companies are: Wockhardt LTD, Cadia Healthcare and Sandoz, Inc. I would appreciate any help.


I would like to hear more of this discussion.

I have had problems with generic drugs not working, I'm in Texas and they are NOT always identical. I was just talking to a friend (ALSO in Texas) and she had a problem (drug did not work at all - a sleep aid) and was told by the pharmacist that she should wait and get refill when they got a different lot number of the drug in, apparently they see differences all the time. She chose to get a new prescription with the brand name.

BTW, forgot to mention that the pharmacist said he had several complaints about the same drug that week.

I am a recently retired pharmacist. I truly wish things were as simple as the pharmacist above named Anthony states.

For many years, I have wanted to believe that generics are as good as brand name drugs. I have been appalled by the prices of brand name drugs and the profits of Big Pharma. I wanted to be able to tell customers that generics are as good as brand name products because that would have been a good way for me to take a stand against the greedy brand name drug companies.

But, like every pharmacist, I kept hearing a signficant number of stories from customers who said that the generic was not as good as the brand name. For years I dismissed these complaints outright. But I began to wonder: "Can all these customers who complain be crazy? Can they all be simply imagining that the generic is not as good?"

No matter what city I worked in, it was not rare that I would encounter customers who would say that a generic was not as good as the brand name version. Of course, customers don't like having a co-pay that is so much higher for brand name drugs companred to generics. They feel their insurance comapny is coercing them into accepting generics. Can those higher co-pays account for all the complaints about the quality of generic drugs? Are these customers just mad at their insurance company?

Every pharmacist has heard many stories from customers telling us things like how often they would have to urinate while taking the brand name diuretic Lasix in comparison to the generic furosemide. Every pharmacist has heard lots of stories from mothers who tell us that their child's behavior worsened when switched from the brand name Ritalin to the generic methylphenidate. Some customers tell us that their depression symptoms worsened on a generic andidepressant, or that they experienced more side effects on the generic. Other customers say their doctor has a harder time keeping their clotting in the target range with the generic for Coumadin. And the examples go on and on. What is a pharmacist to make of all of this? Are all of these customers simply imagining these differences between branded drugs and generics?

We hear that the FDA has inadequate resources to inspect the drug conpanies in this country, much less those in countires like India, China, and Mexico. We go to the FDA website and look under RECALLS and find a very unsettling number of recalls at both brand name companies and generic companies.

Two or three years ago, I think it was the Pittsburgh PostGazette that did an expose' on the huge (and well-regarded) generic manufacturer Mylan, whose plant is not far from Pittsburgh. Mylan is always rated very high among pharmacists in polls in magazines like Drug Topics that regularly ask pharmacists to rate generic manufacturers according to our perception of the quality of their products. Anyway, the reporters in this expose' interviewed many Mylan employees who said that short-cuts were taken too often, that satisfying production goals too often interfered with quality control.

The cover story for the current issue of Bloomberg Business Week is about the "Quality Catastrophe" at Johnson & Johnson, a company that, until recently, had a stellar reputation.

Yet, somehow, even with all these questions about quality control in plants in this country and around the world.....somehow, the FDA still tells us that the end product on pharmacy shelves is just fine. Out of a system in chaos, somehow, magically, the end product is just fine. When there are so many questions about quality control in the pharmaceutical industry, how can we as pharmacists act as if there is no controversy here? Are we being honest with our customers? Any pharmacist who takes the time to invesgitage this issue comes away scratching his head, wondering whether the FDA does indeed have a good handle on the issue.

Many pharmacists sseem to have almost a religious belief that all generics are as good as brand name drugs. Attempting to tell these pharmacists otherwise is like criticizing their religion. They get very upset and defensive.

During my career as a pharmacist, I wish I could have had complete faith in all of the generic drugs I dispensed. I wish I hadn't heard customer complaints about the quality of generic products. I wish I hadn't seen so many articles and news releases about major quality control issues in the pharmaceutical industry in this country and around the world. I always hated Big Pharma for their outrageous pricing of drugs, so I would have had a great way to get back at them by strongly recommending generic alternatives. But, intellectually, I was being dishonest with myself and with the customers for whom I filled prescriptions.

It is a fact that there is a wide variety of opinions among pharmacists about the issue of the quality of generic drugs. Some pharmacists are huge fans of generic drugs as an alternative to the price gouging by Big Pharma. Other pharmacists are not so sure that the race to find the lowest-cost suppliers necessarily delivers a product of top quality. It is a fact that the confidence level among pharmacists about generic drugs covers a wide spectrum.

If Johnson & Johnson, a company that, until recently, had a stellar reputation, has serious problems with quality control, why should we as pharmacists assume that drugs manufactured WHO KNOWS WHERE are fine? What do we base that on? Here's one paragraph from the BusinessWeek cover story on Johnson & Johnson......

"The DuPuy Crisis is one of more than 50 voluntary product recalls that J&J has issued just since the start of 2010, covering brand name drugs that read like an inventory of the family medicine cabinet. Tylenol and St. Joseph Aspirin were recalled for foul odors people said made them sick. Benadryl and Zyrtec were recalled for botched amounts of ingredients. Rolaids were recalled for contaiing bits of wood and metal. Most of these drugstore stalwarts come from J&J's McNeil Consumer Healthcare unit, which has been plagued by dismaying revelations about the conditions and lax controls at its factories in the U.S. It shuttered one factory in Fort Washington, Pa., for a quality overhaul. Under a Mar. 10 consent decreee, the plant and two others--in Lancaster, Pa., and Puerto Rico--will remain under Food and Drug Administration (FDA) oversight for five years. J&J McNeil faces fines of $10 million per year if the agency isn't satisfied with its progress."

All I know is that the very first generic I took for Cardizem, I ended up almost fainting at the dr's, with my heart doing odd stuff. I was put on a bed with a nurse monitoring me for an hour before I felt well enough to go home (one Cardizem in the morning for years gave me no trouble).

I have to pay over $100 for the brand name but do it. I took generic for Cozaar just fine, until the next bottle came and my b.p. was terrible. A new bottle came and it had a different shape. I called Medco and was told it was fine, just a different manufacturer. Well, good - these are working fine!

Now tell me again how they are all the same? I do take 3 generics that are okay. Something needs to be done about this.

Hi, You don't know. You're just guessing. The creator's designs have to be followed. There is no discussion. Do 10,000 experiments and you will also know. IR scans dictate that the medicines are identical. Inherent variations in the human body regarding ADME are great even though the medicines are orders of magnitude more exact. Don't write till you know. pg over and out.

Recently a pharmaceutical representative told me this difference between brand name and generic drugs, and I have wondered if it is accurate or just PR by a drug company. He said that brand names are able to fluctuate 3 percent up or down in the stated dosage, while generics are allowed to fluctuate 20 percent. He said that this accounts for the lack of effectiveness for some drugs, which may not matter so much in something like acetaminophen, but in an anti-seizure medication could make a huge difference. Can you comment on the accuracy of this?

PEOPLE'S PHARMACY RESPONSE:

The information is inaccurate. There is no difference between brand name and generic drugs when it comes to the fluctuation you describe above. The actual description of the amount drugs may fluctuate is a statistical construct that is very complicated to explain. Suffice it to say that this fluctuation allowance only matters if someone is actually testing and monitoring and is scrupulously honest. We fear that is not always the case.

We believe that the honor system should not be permitted when it comes to pharmaceuticals. Sadly, though, the FDA does not routinely test prescription or OTC medications off pharmacy shelves. Since no other government agency (state or federal) has the resources to test, we are at the mercy of the manufacturers, wholesalers and repackagers to do the right thing.

I took Flonase for years to prevent the ear and sinus infections I experienced every spring and summer. As soon as I was switched to the generic fluticosome propionate, I again experienced repeated severe ear infections that resulted in lost work, several doctor visits, and lots of strong antibiotics and steroids. The return to the brand name Flonase has yielded no further problems.

I was encouraged strongly by my insurance company to use the generic version. Once I pointed out to them the cost difference in the brand name versus the doctor visits and medicine costs, I was no longer bothered with calls to change. However, I still had to pay the high price for the brand name myself. It was worth it.

I very much want to know who wrote the article and where that person is employed. Formerly, I regarded the FDA very highly; now, with more budget cuts in the last years than anyone can count, I doubt they do an effective job. I only hope we can still trust our safety to them.

Nevertheless, the identity of the author of the comments above is relevant to knowing whose axe he/she is grinding. Is, just for example, Johnson and Johnson responsible for that opinion, or an independent chemist qualified to give a believable opinion?

Development costs are staggering, truly. But, if one cannot afford the brand, a generic probably still serves better than nothing at all.

PEOPLE'S PHARMACY RESPONSE:

The article in question comes from The People's Pharmacy. We have NO relationship (financial or otherwise) with Johnson & Johnson or ANY pharmaceutical manufacturer. Please go to About The Graedons to find out more:
http://www.peoplespharmacy.com/about/

problem with ambien. one refill was useless. the next refill worked.

Is there any way to determine the source of generic meds?

I have express my views FDA do inspect plants overseas. Last year in fact, Ranbaxy plant in India was shut down due to FDA inspection.

Thank you.

PS- Ranbaxy have good products line & adhere to GMP.

As someone who has used many generic medications in the past without difficulty, I have recently encountered a huge problem with generic Effexor (venlafaxine) which is time-released. Within days of switching to the generic, I encountered severe headaches, dizziness, and eventually depressive symptoms.

My psychiatrist is convinced that it is related to the time-release component of the medication and has switched me back to the name brand. Unfortunately my medical insurance refuses to pay for Effexor XR, forcing me to purchase it from Canada. Otherwise I could not afford it.

The prescription drug administrator that I have refuses to acknowledge that there is a problem yet I have spoken to others on-line who have encountered the same difficulties.

I have had problems with generics also... but try to get the Dr. or (some) pharmacists to listen and not think I am neurotic!

One generic of Doxycycline is fine for me... other not. Same with generic for Hydroxyzine (its for allergic reactions... but the blue one gives me problems--go figure!)

Recently needed Rx for Cipro--remembered that several years ago an Rx for that gave me bad rash and problems--checked and it had been a generic! So, this time asked for BRAND--(was my only option after test for antibiotic). I was willing to try it and to pay the $$$--
BUT (here's my issue) NOT ONLY WILL MY INSURANCE NOT PAY OR COUNT IT TOWARDS MY DEDUCTIBLE ( as BRAND) BUT MY REGULAR PHARMACY 10+ YRS NOT ONLY DOES NOT CARRY IT--BUT IS NOT ALLOWED TO ORDER IT FOR ME! Why?

I had to call 3 other places to find a pharmacy (big chain) who had "some left" and was not likely to get more of the brand. I just don't understand it. Why are they NOT ALLOWED to order it?

I have also heard that "Brand" drugs are sometimes sold/distributed also as generic. A pharmacy tech told me once that for one drug the 'brand' and generic came from the same company/place and were the same--??? I bought the brand anyway. She thought I was foolish..?

I'm thinking if I am sick and need a drug, I DON'T need something unknown to complicate matters... just wish it were not so expensive.
Thanks for bringing this out for discussion--I knew I wasn't the only one!

SH--- I sell MEDICARE ADVANTAGE PLANS---try this--- file what is called and---EXCEPTION-- check your "EVIDENCE of COVERAGE BOOK-- if they deny your EXCEPTION-- file an appeal--- if that is denied ---call the company who make the medicine---they all have a --- PATIENT'S ASSISTANCE PROGRAM--and tell them what is happening and that your doctor wants you on their drug but you can't afford it---they will send you paperwork to fill out -- fill it out and send it back in and call them a week or so later and keep pushing them-- you will need a letter from your doctor to send in with the paperwork---

That worked for me. I now get my SIMCOR for free---which I probably will quit taking as it is not doing me any good.

Paul

Pharmacist Anthony, above, has certainly been brain-washed by the rhetoric and propaganda he has heard and been given. When I complained to my pharmacist about the generic not working, he essentially said it was all in my head, that they are exactly the same as the brand. I could not shake his opinion.

The pharmacist continuously tried to get me to change from brand to generic. The insurance companies do not want to pay for a brand if there is a generic. It is a matter of who can hold out the longest. When I have asked my doctor to insist on a brand name and he writes a letter insisting on it, the insurance will usually give in. Doctors do not like doing this. Otherwise, it comes out of my pocket.

The insurance company won't even pay the portion they usually pay for generics. Eventually, insurance companies rule and send you letters telling you when they will no longer pay for brand names. I continue to have problems with generics. How do I know? Because EVERY prescription I take or use was first given to me as a brand name BEFORE THE SWITCH. I have been able to go back to the brand if it became available OTC, because the generic just stopped working.

Hmmmm, let's see..... Medication produced in China, Mexico, India and Brazil. Well, that's just more persuasion for me to stay off the hard stuff with supplements, vitamins and fingers crossed. And the reason these medications cannot be produced here in the USA? And the reasons why the FDA cannot inspect them when the stuff hits the USA? And the reasons why the FDA seems to shill for Big Pharma instead of protecting the ordinary citizen?

I wish I could express admiration for the harsh attitude exercised by the Chinese toward their FDA equivalent, but it would not squeak by the censors.

Mark RPh, thank you for your frank discussion and honest assessment. Your response was much appreciated

Hello:

I work for a generic company in the U.S.A. As is often the case, there is much misinformation about generic drugs floating around.

Yes, they can have different inactive ingredients, yes they can have different blood levels within prescribed ranges. Yes they can not work as well as brand drugs or, equally possible, they can work better than brand drugs.

I cannot name my company because this is a personal opinion, but the world of pharmaceutical manufcatruing is very complicated. We (generic manufacturer) make "brand name" drugs for Merck, Pfizer, Johnson and Johnson, Axcan, Salix etc. Do not be so sure your brand is made by a brand company. Pfizer recently has a recall because the Indian manufacturer was shut down by FDA.

The botton line is it is important not to switch back and forth between brand and generic or even generic to generic on many drugs.

A few comments.

Graedons, thank you again for your wonderful work. I have had numerous problems with generics over the years, some serious - and have encountered many robotic medical people who just parrot the same old line "generics are exactly the same as brand name." Maybe, maybe not, who knows any more? Forums like this one, where the general public can share experiences are the places where I go to find out the real truth these days.

I've had big problems getting adequate information about prescriptions (due to allergies, I have to avoid certain common filler ingredients) as well as problems getting brand name drugs - yes, they cost way too much, I read some markups can run as high as 10,000 percent! WOW. My major problems in getting brand name drugs were at pharmacies in groceries or discount stores. I now patronize only my local NeighborCare Pharmacy, and the pharmacist there is absolutely wonderful. If he has to special order a drug for me, he does it - other pharmacies won't bother. He will take time to sit with me and discuss options, side effects, generics, etc. He has printed out information about drugs from his database. I'm sure they charge a little bit more than the pharmacy at my local big box store, but it's worth it to me for the professional service and knowledge I get. Here's what I did - when the pharmacies weren't giving me good service, I took my business to a place that would. Money talks, even in small amounts.

The honor system doesn't work. It didn't work when I went to private school with some (now) very successful people who always cheated in the back of the class, or when the teachers left for a smoke break and said "remember, everyone is on the honor system." What a joke. And they graded on the curve. So not being a cheater meant never getting the highest grade, even if it was deserved. (Miraculously though, yours truly was the only one who got a Nat. Merit Scholarship out of the bunch in my class. I never cheated. I studied.) But I am sure these people continue to cheat in their professional lives. There were a lot of them at school, and there are a lot of them in any place of business. Rarely do they get caught. They cover for each other. Their parents and friends "fix it" if they do get caught. Recently Dr. Phil had a show about cheating, and he revealed a survey of students listed in Who's Who in American High Schools (I believe it covered 1995 to present years) - the so-called "cream of the crop" - the Ivy League crowd. 80% of them ADMITTED to cheating.

And to EJM, you're right, the trick is to find a drug that works for you and stick with it. However, the pharmacies can and do switch drugs around without asking or telling you. You have to check the bottle and the label, and the pills inside, before you leave.

I liked your article. I do not like Generic drugs. I had to take a generic antibiotic. I went through two generic antibiotics, they did not work. So I requested Levaquin a name brand and it cleared my problem up. I do not trust nothing coming from over seas! There is a lot of cover up and greed. Americans needs to wake up and smell the coffee. I will pay extra money for a name brand drug. And really I don't trust the FDA either!

I have read every posted comment and am left truly concerned, upset, baffled and confused. Some of the comments are apparently from pharmacists confused about generics they themselves dispense. And the comment by "Rx" really just deflates my hope that things might be okay in our future. Isn't anyone at the helm of the ship?

I use to take Xanax, brand, and was always pleased. Then d/t incompetency, the economy went South and my insurance company refused to pay for brand so I paid for it myself as I tried the generic and found it to be inferior.

I paid for the brand name for a few months then one month I went for the refill, it had increased from $40 to $60. Somehow I feel it was the pharmacy who increased the amount as they do not like filling the brand name drug much. I would always have to call to tell them I wanted brand name, otherwise when I arrived for pick-up, the generic would be filled even though I have been purchasing the brand. It's like the pharmacy tries to cram the generic down your throat.

I am a supplier of bulk Active Pharmaceutical Ingredients (API'S). The vast majority of my customers are US generic manufacturers. All of my API suppliers are European therefore my US customers are using European made active ingredients.
European regulatory and quality standards are equal to or many times more strict than US standards. All of my suppliers are FDA inspected every 2 or 3 years. In other words you do not have to worry about European made products.

Indian and Chinese made active ingredients are another story however. There are so many producers in those countries that the FDA has no chance of inspecting them all. In my opinion no active ingredient produced by an un-inspected factory should be allowed to be sold in this country. It has always been my experience that that was the law here. No customer of mine would consider using any material from an un-inspected supplier.

Sadly most of the active ingredients used here are made in China and India. There is only one reason for this: price. My European suppliers cannot compete with those 2 countries. Labor costs and environmental requirements are large cost factors.
Statistically brand name companies have more failed FDA inspections than do the generic companies.

I wish that it would be clearly stated where the product was produced on each prescription label. I fully believe in generic medicine. Indian and Chinese made medicine does concern me however. I could go on and on with this and would be happy to if anyone cares.

my pharmacist recently explained my generic metformin was changed to another generic brand and it is not as effective as the first generic-my blood sugar was 15-20 points higher than with the first medication-i complained to my pharmacist and was told it is the same and i havent reached my maximum dosage-i am trying to reduce my medication not increase it-my drug plan wont cover brand name medication and so i am stuck-i complained to to fda also and was told the same old story-it is the same-quality control costs money and nobody cares

I unfortunately prescribed generic (compounded) itraconazole for a case of blastomycosis. It was always odd to me that sporonox capsules had beads with the itraconazole coating the beads which I now know is because the drug is absorbed slowly and poorly unless it gets down in the gut and allows time for the drug to be absorbed. The "compounded generic itraconazole" is not coated on beads accounting for the poor absorbability and of course failure to treat mycotic disease in my case. I don't think I will do that again.

I have always received good generics from the Target Store Pharmacy.

If your prescription went through your insurance, the pharmacy receipt has the price (copay) your insurance has electronically transmitted to the pharmacy when your prescription was electronically billed to them. You should question your insurance company about the reason for the change in price. Sometimes your price will be higher until you satisfy your deductible & insurances often raise copays for brand name when a generic drug for it comes out.

I am also a newly retired pharmacist on several generic drugs; I have found it helpful to request that certain of my prescriptions are always filled with the same generic brand. If a generic tablet is not specially coated or time released, I usually break the tablet in two and take both halves; this increases the surface area of the pill exposed to your stomach acid and I figure I will get the maximum drug out of the tablet.

I contacted two pharmacies to find out the bioequivalency of a generic drug and both were unable to give me that information. I was told they could tell me but I guess it depends which pharmacy you contact.

I am having the same type of issues with the generic Effexor XR (venlafaxine), 150mg. I have been on the brand name for about 7 years and was doing great. When my insurance company required me to switch to the generic I didn't complain at first because I was assured it was identical and it was a lot cheaper.

After 6 months of going to the doctor for what I thought were facts of getting older, I realized one day that I just couldn't fight the tears back anymore and told my doctor I didn't think the generic was working. After we looked at my past 6 months and the changes that were occurring, we decided to switch me back to the brand name.

The insurance company refused to pay for the brand name and because I just wanted to start to feel better and see if this might actually be the reason, I just paid for it. After one month of taking the brand name I gradually started back upward. My doctor is convinced and has written a letter of all the physical improvements that have occurred by going back to the brand name, but my insurance company is only "authorizing" me to pay the difference between the cost of the generic and the main brand instead of my RX deductable; although this written authorization is not being recognized by the insurance company when I had to get a refill and has been another battle and seems to be an attempt to bully me to pay full cost.

I'm very interested in knowing how Americans are purchasing name brand drugs from Canada- any direction would be very appreciated.

BG--- see my comment above about filling an EXCEPTION with your insurance company and if they deny file an APPEAL.
All the information in in a book they sent you titled--- EVIDENCE OF COVERAGE --

If you can't find your book call your Insurance Company and ask for INSTRUCTION & PAPERWORK--sometimes that alone scares them into changing their mind.

When you first call asked to speak to their FORMULA RY DEPARTMENT and ask them which companies their pills request go thru.

Good Luck,

Paul 43

I am a chemist who has worked for three generic drug companies over the last 20 years. I have worked in product development and now I work in regulatory affairs, preparing applications for FDA approval; therefore I see every aspect of manufacturing and testing for each product. I think The Soapbox article has a reasonable amount of correct information; however I would like to comment about the overseas manufacturing.

The Soapbox author states that many of the active and inactive ingredients come from abroad. This is true; however the generic companies frequently use the same suppliers as the brand companies. For example, there are only 9 companies worldwide who manufacture the active ingredient pseudoephedrine (a decongestant used in cold and allergy meds). For some inactive ingredients such as colors there are even fewer manufacturers. Thus there are limited choices for both brand and generic manufacturers to buy their ingredients, and often they are from the same supplier, and if not the same supplier, they are the same grade; this is a requirement for FDA approval.

Also I question the accuracy of the estimate that 40% of generic meds are manufactured overseas. That has certainly not been my experience; in my career I have filed over 50 generic drugs for FDA approval and only one of them was manufactured overseas. Every other product was manufactured in the United States, and all three companies I have worked for received at minimum a yearly visit from the FDA. Thanks for a great discussion.

The generic for cipro has been out for a while... Perhaps the manufacturer for the brand was having a shortage or long-term back order, or maybe they just quit making it entirely? Most people opt for the generic anyways. Also, even if the brand is still being made, that doesn't mean that the pharmacy is able to order it. Their supplier may not be contracted with the manufacturer of cipro.

Also, as a pharmacy tech myself, I have seen a few drugs that are generic, but are literally the same tablets as the brand. You can open the bottle or pouch and see. They have the same markings and are from the same manufacturer. Some companies do this when their patent is about to expire in order to continue making money from the drug, instead of losing it to competitors. Most are birth control pills that do this, but since it takes 20 years for a patent to expire I wouldn't doubt if more companies do it in the future.

I am another person who cannot take generics. I have tried, over the last 5 years to go generic for my meds. I have had a rash and welts on my body for 5 years. I took name brand (same brand) blood pressure and cholesterol meds for about 10 years with no problem. When these same drugs went generic my insurance company automatically switched me to generic. That's when my problems started.

I actually went off all of my meds for one month and all rash and welts disappeared. But that could have been disastrous. Also, I did take generic acid reflux meds for 6 months with no problem. When I renewed the 3rd time, I got a roaring red rash all over my body and switched back to Nexium. So they can't tell me they are identical.

I can't afford the blood pressure meds on my own and my insurance doesn't carry them anymore in their formulary. I've switched to another brand blood pressure med, that my doctor gave me samples for and my insurance covers. I've been on it for a week so far and no change yet. But, I know it takes longer than a week so I'll wait and see. But it sure does get to be a challenge.

I also wonder about the generics that are made in other countries like China and wonder, since they are not checked by the FDA. Could it be something like the dog food problem we had awhile ago? Who knows.

I was switched from one generic brand of ranitidine to another cheaper for the pharmacy brand, I noticed side effects, reflux, acidity that I was unfamiliar with, I called the pharmacy and they told me they had been having problems with that brand and then tried to get me some of the previous stuff even went as far as calling a competitor for it, told me to maybe get a different prescription from doctor, as they cannot get previous brand anymore, I wasn't expecting that response I was expecting them to tell me that there was nothing wrong with drug and maybe I had an ulcer or something like that, so there is a difference between generic brands and they don't seem to care about my health only making money.

SOME PEOPLE (LIKE ME) can't take generic drugs.

CPMT--- did you ever stop to think that all GENERIC drugs were BRAND NAME drugs until the patent time ran out and then they magically became GENERIC DRUGS at a 1/10 of the cost!!!!!

Here's a good one - I started on a medication ordered by my MD and because I requested brand name only from the pharmacy, I was told to go some place else for medication. Not that the pharmacy could not acquire the brand name, they just did not want to. I recall the days when a consumer was given the choice prior to being filled.

PEOPLE'S PHARMACY-PLEASE ANSWER!!!

My problem IS NOT Brand vs. Generic, but Generic vs. Generic. I have severe back and knee pain. When I refilled my pain med about 4 months ago, I noticed it was from a different Manufactuer. I didn't think anything of it. After I took it I became extremely sleepy.(never happened before).Also it only helped my pain a little, about 10%. My other Generic helped about 75-80%. Big difference. I called my Pharmacist(known 16Yrs.)

He said he was having trouble getting Med from other Co. but would keep trying. I have heard about shortages of Generic Meds, caused by the Drug Companies themselves, and it's all about money. People are suffering because of the
policies of the Insurance and Drug Co. Is there anything I can do??? I can't change pain med because others have side effects.

PLEASE ANSWER!!! Thank You!

PEOPLE'S PHARMACY RESPONSE:

We have heard similar stories many times. Although the FDA insists that all generic drugs are identical to the brand name, we have our doubts. Since the FDA cannot inspect all the manufacturing plants abroad (where so many generic drugs are made) we have no way of knowing what is going on in some of those Chinese and Indian chemistry plants.

Botton line: people report changes when they are switched from one generic manufacturer to another. We suspect that there are differences that account for the clinical outcomes. When you find a generic that works, ask the pharmacy to stick with it for you!

Just heard the same thing for the generic/name brand being the same via one of the big mail order prescription distribution centers. The difference in price is considerable. It's not for most drugs but there are a handful that the generic and name brand are the identical pill.

some people are allergic to the fillers... which are different.

I have had problems with generics, the same medication made by different manufactors. I have had problems from one brand but when I go for a refill and given a different brand I shape and color I am told that I is the same medication but the effect from the different brands hasent been the same. I am talking about generics mfg. Also I you find a generic that works, why is it that when it is time for a refill the pharmacy dont carry it anymore wont order it and can not find it at any other pharmacy. talked to the company that make the medication was told by them that the medication is still being made and that I should be able to get it, there is no back up orders. there need to be a solution to this problem. it you have a medication that works with no problem you should be able to continue to buy it. How can I find which pharmacy that carry a certain generic brand. Help!'

Sorry, but you're wrong. They are the same. You carry this silly idea that generics are inferior just like 95% of the other morons who gladly pay 700% more for the same drug.

Wow, there is so much idiocy in the comments here. What do you morons not understand about generics being required by law to contain the EXACT SAME ACTIVE INGREDIENTS AND BE ADMINISTERED IN THE EXACT SAME WAY, AND TIME FRAME?

I can't wait until the day when you morons realize that you've been overpaying for drugs by up to 1000% in some cases just for the brand name. That's all your buying....THE BRAND..

Wow, now there is an example of someone not paying attention to what is being written, and who has a scary high opinion of themselves and their assumptions.

But back to the subject:
I proudly pay for my subscription to Consumer Lab. The company was apparently started by a doctor who got sick and tired of the lack of regulation and oversight for herbal drugs in America. Thanks to their testing, I feel I can successfully stay away from the supplements that have lead/mercury/etc or do not contain what their labels claim they contain.

I don't suppose there's a doctor (or pharmacist) out there who is sick of the lack of oversight of the prescription drugs out there and wants to start a similar company testing brand names and generics? If you do at least a decent job, I will happily pay a reasonable yearly subscription fee.

Something not mentioned above is that generic drugs are only required to be 80% efficacious, not 100% .

People's Pharmacy response: The requirement applies not to efficacity, but to "bioequivalence"--the amount of drug that gets into the bloodstream has to be between 80 and 125 % of the stated amount, subject to a lot of statistical qualifications. That also applies to brand-name drugs, but most brand-name companies have quality control measures that don't allow so much variability. It is actually pretty complicated.

Generic drugs are assumed to be just as effective as their brand name counterparts, but that might be a whole lot less than 100 %.

I read the People’s Pharmacy column today in my local paper where someone wrote in & said: “I can’t believe so many people complain about generic drugs on your website. Generics are required by law to contain the same active ingredients in the same quantities. I am really disappointed that the People’s Pharmacy offers a forum to uninformed morons who don’t mind paying 700% more for a brand name”

I find it very odd this person calls those who complain about generics “uninformed morons” (perhaps this is "generics" who is posted here?) I am sorry to tell this person but they are the uninformed moron in this case. They should go to the FDA website & read information about generic drug approval requirements as well as the Code of Federal Regulations (CFR Part 314.92 -314.94) to understand what the requirements truly are and the variances allowed.

The costs to bring a drug to market (not to mention the time, usually 7 - 10 years) are high, often well into the triple digit millions. Many studies are conducted for safety & efficacy in both healthy subjects and in patients with the indication the drug is intended for. All of the FDA requirements must be met & are quite strict. After the drug is approved (if it even gets to that stage!), the drug company has 7 years to recover their investment into the development & extensive (expensive) clinical trials of the drug. Then a generic manufacturer can come in, do 1 (ONE!!) clinical study to test ONLY to prove bioequivalency/bioavailability in their version of this drug and request approval. The generic manufacturers DO NOT have to prove safety or efficacy of their generic version of the brand drug, only BE/BA.

While the active pharmaceutical ingredient (API) may have the same chemical formulation, it likely is not manufactured in the exact same manner & specifications as the branded drug (that information stays proprietary to the brand manufacturer), in addition, the inactive ingredients (chemicals used to make that tablet bind together for example) are often not the same & many of those "inactive ingredients" are now being manufactured in countries where the laws governing standards are lax (China, India, etc). Those inactive ingredients often can radically influence the effect of the drug (again, remember! no studies are required for efficacy/safety to get a generic approved).

So bottom line, while you pay less, you do not know if you really are getting EXACTLY the same drug. The generics are not "exactly" the same, they are "identical"; which does not have the same definition.

In addition, when you get your generic drug, it may not be manufactured by the same company each time your prescription is filled. Pharmacies purchase the lowest cost generic available at the time they are placing their orders, that means you might get your generic manufactured by Generic Company 1 and have no problems but then you get your next refill now it is coming from Generic Drug Company 2 and suddenly doesn't work the same.

So my response to the person calling those who question generics is they need to do some research before calling others “uninformed morons”. There are issues with generics and while the Waxman-Hatch Act (Drug Price Competition and Patent Term Restoration Act of 1984) was originally intended to offer fair pricing so no company had a monopoly on a drug & able to sell it at whatever price they chose for as long as they chose (beyond recovering development costs & making a profit... yes, it is ok to make a profit, we are still a capitalist society), it now has been abused and we receive generics with ingredients from who knows where. There needs to be modifications to the CFR to address these issues.

So, "generic"... how would you like to come up with an idea, you create it, you manufacture it, you spend years & lots of money on it, then someone comes along & makes something "identical" but not exactly the same (i.e., doesn't use the same quality parts/materials that you did), sells it for less, and now everyone is complaining about how you ripped them off all those years making them pay more for your original idea than for the knock off?

Same idea... except these are things we are putting into our body... there needs to be more standards and laws controlling generic drugs.

There is a need for generics, and there are many generic manufacturers that comply with all GMP & GLP requirements, but as noted in earlier posts, there are many that do not. The FDA does not have the staff to audit every facility as often as should be done not to mention any overseas manufacturing facilities. People make nasty comments about "greedy Big Pharma"... well generics are right up there too!! Do not think for one minute that the generic manufacturers are making them "out of the goodness of their hearts"!! HA!! They cut corners to cut costs (and thus sell more) and it is the consumer who suffers... in the case of drugs, that would be you & me!! No one is without blame in the issue of pharmaceutical drugs.

Does the pharmacist know in what country the drug is made? How can I find out the maker of two generic medications?

People's Pharmacy response: The pharmacist can check on the maker if you ask when the drug is dispensed or right afterward. S/He may not know where the maker is based, but you may be able to find out by looking for the generic maker online.

If several weeks have passed since the prescriptions were filled, it may be difficult for the pharmacist to figure out which maker was used.

Generics:

Some understand what you are saying. They both contain equal ammounts of the drug. However.... the fillers and releasing agents used in such meds (like Wellbutrin) can be different.

Example - I was on Wellbutrin XL 300mgs for over 2 years and was doing just fine. When I was switched to a generic brand, the release of bupropion was much faster, causing me to have bad reactions to it. I know what you're thinking... Placebo? I was on the generic for over 4 months. When I couldn't take the rush of meds being dumped into my system anymore, I tried another generic. I found that this too didn't help.

My doctor now prescribes brand only for me. I order through Canada. The difference to me, is there.

I will not say that is true for ALL meds. I have been on generics before for other things and it worked just fine. The problem I had with this one was the time release agents being used.

You can believe me, or think I too am a moron. I was just sharing my life experience.

This is a very interesting and informative Discussion - thank you. I'm glad to know I'm not alone in having a problem with generic drugs. Can I find out what pharmacies support American-made generics?

I am from Canada and was checking up on my mother after her doctor appointment, who has high blood pressure. Her doctor mentioned to her yesterday that the pharmacy changed her blood pressure medicine to a generic prescription without telling her. Her doctor was livid!! and told her she could have had a heart attack or a stroke!! Who then would be liable if this happens?

I noticed on her pill bottle that they put the name of the prescribed drug on the bottle, then underneath the generic form they substitute it with. How are we to know? Are we pharmacists?

The pharmacy won't change the prescription back to what the doctor prescribed, they say that is up to head office. If these big pharmacies are crowding out the smaller pharmacies, why does that give them free license to prescribe whatever makes them more money without taking into consideration the health and well being of their customer?

This is the second time this pharmacy has done this, they also switched her ant-acid from zantac to ranitidine, which gives her worse heartburn from the filler that is used to make the pill. Who is going to help control this? I think a poll should be started to track these pharmacy companies, this feels illegal, they are pedaling drugs at their own discretion, without consulting the prescribing doctor, or patient!!

The pharmacies, health insurance companies do what ever they dam will please.
You no longer have choices. Brings one to the question what are THEY really dishing-out. Like the chemo drug being given to children - diluted. One use to have to worry about counting pills and checking the label and color were the usual. Now "take at your own risk".

Doctors no longer have the prestige and respect they once were awarded. Used to be doctors had the final word. Even if you are willing to pay an inflated price to receive the name brand, THEY will conveniently not be able to get the name brand. Bet the slime elites do not have to deal with this corralling of the cattle and in regards to the congress and others, we the people pay for them to have the best. Unbelievable.

I am writing to all of you who have experienced differences between the brand name and the generic medication. We are not imagining it, it has nothing to do with the cost and we are not morons like "generics" thinks we are. I am a 58 year old female who happens to take Ritalin LA for Adult ADHD. You can ask anyone in my family, any of my friends, my doctors and the people who work with me and they will all tell you that there is a world of difference when I take the medicine and when I don't.

Just several days ago I received Methylphenidate ER from my pharmacy (a generic) instead of the usual Ritalin LA. I had been taking two 10 mgs per dosage of the Ritalin LA and to simplify things my doctor wrote the prescription for one 20 mg per dosage. It seemed like a good idea because I would require less pills! I didn't realize I had something different but my behavior over several days was as if I wasn't taking any medication at all.

I started to wonder what it was I was taking since I was struggling so much and to my surprise I was taking the generic medication instead of the brand name. So "generics" please explain why this would happen to me if the are exactly the same?

As a Registered Nurse and Disease Management Patient Educator, I speak by telephone with thousands of patients around in 17 states year after year, teaching them about medication, medication safety, things to ask the pharmacist and physician or provider to remain safe and get the most out of their treatment. I also help them find ways to save when they can so that they can afford the care they need.

For me as a nurse and patient, the issue of generics is NOT confusing nor controversial: It's a no-brainer. The drugs are not the same, and won't usually work exactly the same. Usually it will be very similar, and that's it. Because the generics use cheaper inert ingredients, they carry some risk of mildly inferior overall effectiveness and safety. Occasionally they be much inferior and could even in some cases (rarely) work better.

I look at it the same way I would a food or cosmetic product, because the principles are the same. Most hand lotion, for example, is made from some sort of animal, vegetable or petroleum-based fat to replace oil and soften the skin, and various types of wax, and chemicals aimed at dispersing ingredients, trapping water near the skin, etc., to keep it plump and soft. There would be fragrance, dye, and preservatives. The quality of those ingredients could vary widely, from dirt cheap to rare and precious. Basically, though, it's oil, water, chemicals and wax.

Now let's say that "medicinals" like vitamin E or botanical extracts are added. These parts are identical in each bottle of lotion. If we bought the lotion for the effects of the "medicinal ingredients", the effect of any of them on our skin ought to be identical. But they're not, because of the "vehicle" they're riding in. Some inert ingredients melt better on the skin, hold the medicinal in place on the skin, make it absorb more slowly or quickly, etc. The "inactive" ingredients could range from additionally soothing and moisturizing in effect, all he way up to as harsh and irritating as any cheap floor detergent would be, and we could be allergic to ingredients--especially dye or fragrances-- used in any of them--expensive or cheap.

In short, the quality and actions of the inactive ingredients could help or hinder the overall intended effect, and greatly alter the behavior of the "active" ingredients you purchase the lotion to get. Although the analogy is not exact, it seems logical to me that when you switch to a generic, you may experience a change in how well, or in what time frame, you absorb the medicine because of the change in the entire formula or physical construction of the medication. Because cheaper ingredients may be used, they may be ones more likely to cause side effects, allergic reactions (like yellow dye no. 5) and less predictable absorption, too--though not always.

I experienced a dramatic drop in the effectiveness of one medicine I take when the first generic became available, and the pharmacist kindly clued me in that often the solution is to switch to another manufacturer's version, as maybe I can absorb the fillers or my digestive system better dissolves the coating on "generic #2". If it's a hormone like thyroid or estrogen, or a drug that requires a narrow level range in the blood, like warfarin, then the blood levels will need to be checked to see if the required dose is the same on your new brand.

I have heard a few stories where the generic worked BETTER than the brand name, presumably because those inert or structural aspects just worked better in that particular patient's body.

I tell people to try the generics, with these thoughts in mind each time their pharmacy uses a different manufacturer's version, and to report it to their doctor right away if something doesn't feel right, or the blood tests will need to be done.

Of course, I would like to make it be required that drugs used in the US be inspected every day at the manufacturer by an American-paid inspector for safety and quality. That's a serious issue, and I know standards are abused in many places or ignored altogether.

And if I could, I would lobby for restrictions on forced use of generics over the doctor's objection. I would make it a requirement that when a pharmacy starts you on a generic that works for you, they be required to continue supplying it to you from the same manufacturer, for consistency and safety, even if they can save themselves money by making a switch.

AND!

It seems to me we have another new and very scary situation, too, with the "generic brand" drug manufacturers no longer satisfied with being called or (as they see it, stigmatized by) the term "generic". Now they want to give a single drug hundreds of brand names, one for each manufacturer of the same drug. In a day, the number of named drugs can grow exponentially.

In a day, an old and common drug could could become unrecognizable by name to nurses, doctors and pharmacists, unless the patient himself can say, "oh, that's my warfarin," or "my new Coumadin generic". This means a huge loss of protection in emergency situations, even just doing a medication history interview with a patient can much less productive.

As a nurse of 20-plus years I have 1000s of drugs filed in my mind with most of what I need to know about them, and I work hard to stay on top of new developments. I have a computer database I can search. And STILL, when another brand of good old warfarin came on the scene, I had to say, "Huh--what's that??" because the latest brand name wasn't in my database. Not very confidence-inspiring, either.

With no way to recognize a drug that is reliable--color-shape, size, name, ANYTHING!--mistakes will happen more often, and be harder to sort out in an emergency. I see this as potentially very dangerous, especially to people with vision, memory, or language barriers, such as immigrants and the elderly.

When drugs are sent by mail, too, it's a great convenience, but no discussion or even just casual questions between patient and pharmacist happen to provide a second "safety check". (As you know, healthcare workers count on these automatic double and triple built-in safety checks. They've been considered indispensable for safety in healthcare.)

I've seen patients on the same medication from 2 different pharmacies or providers, where no one caught it because when a drug has a brand name, the patient can't say, " what's this the generic of?" and would never know to ask, which is the understandable, but dangerous, intent of the manufacturer.

For those reasons I would also insist that for safety, every patient be taught to use and rely on the generic or chemical name of each drug they take, and this be written in HUGE letters prominently on the center label, in front of the brand name, of EVERY medicine dispensed, whether original "brand", generic, or the new "alternate brand" generics. I would require a red alert notice to be given along with the drug information when the drug was dispensed, so the patient would take note.

When prozac became generic, I was immediately switched to using the generic because it was now available by my health care plan. At the time, in order to have the name brand - I was paying an arm and a leg for it. Then my doctor insisted that they were 'exactly the same' - so I went onto the generic form. I experienced anxiety, sleepless nights, and tremors which led to me to think I had something severely wrong with me and get misdiagnosed with another ailment.

My best friend is a pharmacist and when I told her my issues, she explained that generic was NOT, in fact 'exactly the same'. Thus began the task of paying more for my prescriptions to be name brand, although it's a price I'm willing to pay. The biggest inconvenience is to see when my doctor faxes or emails in a prescription that states on it "refill with BRAND ONLY!" to get to the pharmacy and see it filled with a generic.

I've actually watched my doctor write specifically or send with those instructions - the tragedy here is that for those of us that NEED the actual brand name, we are being forced to pay higher prices and are still facing the attempt of getting those generics rammed down our throats, LITERALLY! I think most 'brandies' will agree with me that if they could pay $4 and utilize the generic, they would - but not at the cost of their own health and well being.

The FDA is having problems regulating drug manufacturing for the same reason the USDA is having problems regulating food products from agricultural production, and other regulatory agencies are having problems in carrying out their responsibilities- BUDGET CUTS. Right-wing political groups want to reduce the size of government, and reduce regulations on business because they mistakenly believe those things are preventing economic recovery. They are not.

Grover Norquist said he wanted to shrink government to a size where he could "drown it in a bathtub". This wrongheaded attitude is exposing the American public to more and more dangers from the drugs, food and products they purchase. The outsourcing of manufacturing to other countries not only costs Americans jobs, but increases the risk of contaminated or dangerous products because very few of those countries even have any FDA or regulatory body looking out for public safety. When are people going to realize that one of the best functions of government is to protect the public from the effects of shortsighted and careless corporate actions?

I have tried to go generic for Keppra (Levetiracetam), an epilepsy drug. I have been on Keppra without a problem for eight years . But I am jobless and Keppra costs thousands a year. To save money I have tried two generics. Neither works. Both cause itching, burning, and lethargy.
Thank you for your support.

I'm unable to take the generic version of the brand medication "Lamictal". It's used to control my epilepsy. I have taken the generic version in the past and my seizures were not controlled. Pharmacists and insurance companies have routinely recommended generic brands to me for cost effective reasons out of ignorance. However, my doctor is aware of this problem.

This 15+ year old Lamictal brand medication has cost my family over $1,200 per month. It is medically necessary to survive. Today we have insurance and I cringe when it's refill time just in case the insurance company decides not to cover the brand. This financial burden has put us in a hardship position many times. Please note that due to the cost of medications, anyone who is medically treated for epilepsy will be declined from a private insurance company, period. Sometimes a high price brand medication just has no generic comparison and this should be noted within the health care industry. I do wish for more competition in the pharmaceutical manufacturing to bring down the price.

I have experienced time and time again the affects of generic medication being prescribed to me by my local doctor. After informing him of the trigger of asthma, and getting a guarantee from him that it would never happen again and he would mark my medication record as such, I now am informed that the doctors are ORDERED by the Australian Gov. to prescribe at least 1 in 10 patients with scripts for these generics WITHOUT informing them whatsoever of the possible reactions. Sadly our pensionsers are the prime target. What a bloody insult.

The consequences of people not being fully informed can be life threatening, as I have just found out. It should be law that every ingredient in medication be clearly and honestly indicated on the packaging of every prescribed medication and associated product. What is actually in these generics medications, other than the active ingredient, and again I believe there is not the quantity of this either, cannot be the same, after all who in this day and age "provides the same for a lessor price".....time to tell the truth doctors, chemists and companies.

Knowingly taking someones life is not legal either all in the name of profits, and in Australia our Government lying as usual to the public with the same outcome is not either.

People treat BRAND drugs as safety blankets and are fooled into believing BRAND drugs are above and beyond SUPERIOR to their generic (IDENTICAL) counterparts. A good chunk of brand companies are actually WORSE than generic companies where they have LAX REGULATIONS by the FDA and the government.

If you do not believe me read this article about Mcneil's mess in 2010 which lead to a shortage of many BRAND NAME DRUGS (TYLENOL,MOTRIN,ETC.)
http://www.washingtonpost.com/wp-dyn/content/article/2010/05/27/AR2010052705484.html

I have taken a generic medication and then was able to afford the brand. Whatever, the schools are telling pharmacy students, is totally not true. Even my doctor said,"yes, the generic brand is SUPPOSED to be the same, however the ingredients have been slightly changed in generics, so the lay person would not even know these "words".

Have someone show you a Brand Name ingredient pill, and have them show you generic ingredients. Again, as a lay person, we won't understand the "words', but your doctor will.

I am so put out with doctors getting irritated at me for acting like I'm crazy when I tell them I cannot take generics. They do nothing for me. I don't get better I just keep getting sicker.

I'm so glad to see postings from people stating the same problems. They act like there is no way anyone couldn't take a generic. Today I went to the doctor and she said she was putting me on a steroid. I told her that the last time I took one, my throat felt like it was closing up. She actually got angry and let me know right away that there was no way anyone could be allergic to a steroid. That's funny, because that's not what the pharmacist said.

We are just a number to doctors and they don't give a care for us. I'm SICK OF IT. A real doctor will listen to you and try to help you instead of getting angry when you NICELY try to tell them something. I think I know my body. And why in the world would I want to pay more for medicine if I didn't have to. Plus all the time it takes to find a pharmacist nice enough to help order the name brand for you. The people who say that generics are the same need to shut up and do their research.

I too worked in the pharmacy industry for a while, went to school for it etc. Like everyone else who went to school for it, I was taught that generics are equivalent to the original brand name versions and like my fellow class mates and coworkers, I actually believed it. At the time, I had never personally had a problem with any of the generic medications I had been prescribed, but I did hear many complaints from customers. I chalked it up to a psychosomatic issue. It was a very ignorant assumption on my behalf.

I have since personally run into a generic medication that was complete garbage compared to the other generic I had been taking prior to that. I didn't even notice the switch when it happened at first because both pills were so similar in appearance. What I did notice was all of a sudden my old symptoms started coming back. I couldn't for the life of me find a reason until I compared a couple of old left over pills lying around from my prior months prescription and realized they weren't the same and I decided to look into the new generic brand and sure enough there were dozens of other people ranting about how it didn't seem to work properly.

For those who doubt that generics aren't necessarily the same go actually read what the law dictates and how it defines "bioequivalence."

Then more importantly read how the studies are set up to prove bioequivalence. (It's ridiculous how flawed the design of these "studies" are. I mean we are talking about the pharmaceutical companies who are trying to get their drugs stamped with approval using a tiny group of a couple dozen healthy test subjects. Until recently the drug companies didn't even have to disclose how many times their drug failed this test to the FDA before they found a batch of pills and test subjects that would pass.)

Then read about how often product is tested after its initial approval. (I'll give you a hint, basically once approved the drug manufacturer is basically on the honor system after that due to how behind and understaffed the FDA is in its work.) Other sobering material to look into is all the various instances of fraud and corruption that revolve around this issue that have come to light over the year.

Then finally just read through a few online forums filled with hundreds of very real and sane people who have personally suffered due to poorly made generics.

First, I would be highly surprised if Texas tests each and every drug. I don't know of any State that has the resources let alone the money to support such a horrendous task. It was my understanding that was the primary purpose of the FDA, however I recently read that the FDA rarely tests any drugs, relying on the pharmaceutical companies to submit testing results and to self police. That includes the foreign drug makers. So much for the government protecting us from bad drugs. I did not read it on the internet, and if I did, would probably not trust it. The article was in our local newspaper, and was backed up by numerous professional sources, including an interview with an FDA official.

Second, there was a comment by a reader (a pharmacist) that he knew of no pharmacist that would put greed before customer safety. I have seen numerous news stories of U.S. Pharmacists that have done exactly that. Remember the pharmacist that was caught adulterating cancer drug formulations? The pharmacist mixed drug was less than 1/5th the appropriate strength. That pharmacist is now in prison. I wonder how many more would come to light if not hushed up by corporate interests. Or gagged by a Tort Lawsuit settlement. And how about the recent revelation that there was a black mold fungus in a large batch of steroid medication used to treat a meningitis outbreak. Was that an innocent mistake or did greed make that manufacturer cut corners. So far 29 people have died.

Here is a quote from the New York Times, "Compounding pharmacies, which mix their own drugs, have had little regulation from either states or the federal government, and several others have been shut down recently after inspections found sanitation problems."

I would hope that this isn't becoming the new norm. I still believe most pharmacists are caring people who do put their patients interests before anything else.

Most of the pharmacies I've done business with in the past have been very good, but I recently changed pharmacies when I felt the generic drugs they were selling me were less than effective. So far the new generics I'm taking seem to be working better.

I think everyone would benefit from the words "Caveat Emptor" Let the buyer beware.

From the age of 84 my mother lived with us for 7 years. She took Lasix (Brand) daily. When the mail order pharmacy sent her the generic Furosimide, we noticed her ankles would swell horribly. She asked our doctor to write "no substitution" on her scrips. I saw for myself the difference. When we would forget to ask for the "no substitution" on the scrip the ankle swelling would happen over again.

Now that she is on a state run program, I cannot get her on Lasix even though Lasix is very cheap. I even offered to pay for it but they will not budge. Not only does this new doctor dismiss our problem, she had someone call me and talk to
me as if I was a little child, totally discounting our findings over the 7 years my mother lived with us. She is now 94 and when I visit her at the facility it breaks my heart to see her feet and ankles so swollen.

Generic Drug effectiveness is a mystery which in more serious cases is probably a death sentence. I found in taking doxazosin to reduce night time trips to urinate that Apotex C did not work at all but it took several weeks after I switched pharmacies to realize that it was the cause of my increased night time trips to the bathroom. Mylan was fairly effective reducing the night time wake ups and TEVA was the most effective. It makes me wonder about trying Cardura but even if it was better I don't know if the patented version would be worth the extra cost to reduce the night time trips by another one or, less likely, even two times a night.

I think generics could be rated more accurately by a reporting system in which the makers were noted as helping more or less than the previous source of the drug. This may not be helpful on some generics that are used only briefly but for those used repeatedly a very inexpensive data base could build up a record for pharmacists and interested patients to review when selecting the manufacturer of their generic

Just learned this plant is under investigation AGAIN for glass shreds in their generic Atorvastatin very concerning.

When I went to the pharmacy to refill my latest Venlafaxine (generic Effexor), I received one 225mg pill instead of 3 75mg pills. I started feeling dizzy and extremely nauseous within a few days. I initially thought the side effects might have been due to the change in dosage size, but it didn't make sense to me that taking 3 75mg pills and 1 225 mg pill would contain different active ingredients or dissolve at such different rates to cause such miserable problems.

After research, I found that changes in the manufacture of a generic can also cause problems, which is what happened to me. Plus, it's now 5-6x more expensive for me to get the prescription because this particular "formulary" is not covered by my insurance.

I just found this site while trying to decide whether to insist my Dr. put me back on brand-only medications entirely, having discovered that I've been swallowing glass for at least a few weeks in my atorvastatin. It amazes me that they make these recalls at the retail level, but patients who are taking the drugs are not alerted. Just because there are not yet any confirmed reports of injuries? How can it be OK that my insides are now swimming with GLASS?! How big does a piece of glass have to be before it's not a good idea to swallow it? How many in each pill before it adds up to a problem?

I was "lucky" enough to obtain a refill on November 8; the pharmacy was alerted to pull the drug from their shelves on the 9th. So I have been taking these for weeks.

My husband takes Depakote ER for a seizure disorder. The pharmacy switched him to a generic, and it wasn't long before he suddenly started having seizures again. After realizing the drugstore had made the switch, his neurologist started requiring BRAND ONLY, and he has not had a seizure in the few years since then. The neurologist said the meds are NOT the same. Even if the active ingredients are the same, they're not necessarily absorbed the same way. I'd say seizures are a pretty clear piece of evidence this is not something patients are imagining.

My bigger general concern is oversight. Yes, things can go wrong in US factories too, but let's face it. There is no way the same kind of US oversight occurs in factories located in India, China, etc. Look at the melamine incidents, and the lead paint in toys. They just don't care about anything but the bottom line in those countries, because they are unregulated and they don't have to care.

I am very close to insisting my Dr. put me back on brand name drugs for all of my medications, and just find a way to deal with the cost. I'd rather lose money than my health.

"The requirement applies not to efficacity, but to "bioequivalence"--the amount of drug that gets into the bloodstream has to be between 80 and 125 % of the stated amount, subject to a lot of statistical qualifications"

Actually, it's the 90% confidence interval of the CMax and AUC that has to fall within the 80-125% of the branded product for it to be considered bioequivalent, which makes it a bit more stringent. Not sure if that's what you meant by "statistical qualifications". There's a lot less variation than it sounds like when you throw around 80-125%. Plus, the brand name manufacturers are allowed the same variation from lot-to-lot as well.

That being said, are all generics exactly the same as brands? No, with one of the main differences being that as long as the CMax and AUC fall into those ranges, the TMax (time to maximal concentration of the drug) can vary. Can this have an effect? In certain situations (i.e., where the effect of a drug is needed right away), possibly. In most situations though, we're dealing with chronic medications that reach steady state concentrations in the body (and don't have narrow therapeutic indices), so the Tmax essentially becomes irrelevant.

As for different inactive ingredients, obviously a patient always has the potential to be allergic to something in a generic medication, just like they could be allergic to something in a brand name medication. But looking through the comments, it's ridiculous that people think just because one generic medication caused an allergy that all generic medications will cause that same allergy. It's not like brand name manufacturers use one particular set of inactive ingredients and generic manufacturers use another- they're all basically mixing and matching the same inactive ingredients to make their products.


how can a pharmacist tell me my dose is too high when I was on brand name switched insurance and now on bad generics. It's the same dose it's identical. What's up and why can't I have the brand name at the generic price if they are both made by the same company they are identical right? I think I'm done taking meds. Pharmacies and drug companies are jerks they want money and that's it they could care less if someone takes a med goes nuts and shoots a bunch of people this is messed up I have had severely different reactions to different generics cause the pharmacy can't carry the same one all of the time because they have to get the cheapest one. So what if the dye gives me a rash or it sends me into instantly feeling like crap they don't care they say the same thing they are identical.

My prescription plan requires me to use mail order pharmacy for my medicine. I was taking a generic medicine to treat heart arrhythmias for over six years, and they kept switching manufacturers. Then they switched to one manufacturer (which made the medicine in America), and began having many problems (angina pain, dizziness, difficulty breathing).

The cardiologist put me on the name brand, and within one hour I could breathe easier, and had a huge reduction in symptoms. I thought maybe I would feel better in a few weeks, not in an hour. Was on the name brand over 2 years, and felt so much better.

Now the manufacturer for the name brand has stopped production, and I must go back to a generic. I have nothing against generics, if they work. I take another medicine that is generic, and have no problems with it. The differences in manufacturers of medicines can make a huge difference for some patients.

It took years for the FDA to admit that the generic Wellbutrin made by Teva was not working, was not "bioequivalent". Think how many people were pushed onto this generic -- often for treating depression -- and were not helped because of the fraud of both Teva and the FDA. The FDA only investigated because of the overwhelming complaints from physicians and patients could no longer be ignored.

Anytime your generic does not work in the same way as your brand name, you should file a report with the FDA. They don't seem to care, and they won't respond for years, but if enough people were filing these reports, they would have to take notice.

https://www.accessdata.fda.gov/scripts/medwatch/medwatch-online.htm

I have a question concerning generic medications and which pharmacy carries which manufacturer of the drugs.
My wife has been taking Roxicodone manufactured by Activis and would like to change to see if another manufacture's product would be more consistent.

She has found that using the current product that on a month to month basis using this medication, the effects had changed drastically. She filled her three week prescription and the drug is not working as it did before and due to the nature of the drug, the prescription cannot be changed mid stream.

We did some research and found many different manufacturers of generic forms of this drug but we are at a loss for finding a pharmacy which carries a different brands.

Short of calling all different pharmacies in my area, is there somewhere I can get this information from one place? We asked our current pharmacy but they said they only carry one brand.

Please help.

Thank you

PEOPLE'S PHARMACY RESPONSE: This would be a great idea for someone to undertake as a business, but we have not seen it. I'm afraid you'll be using the phone.

I don't need a damned doctor or a pharmacist to tell me that the new med I'm taking, which is a different brand of generic drug, is vastly different from both the brand name AND the generic from a different maker of the drug.

this article was helpful in the fact that about two weeks ago the cvs pharmacy I was going to ran out of the Avapro I was taking for my blood pressure... they told me it would be a couple of days, in the meantime they gave me a few pills to suffice... I was taking brand name Avapro not the generic, and so when I called on the day they promised me, they said "oh there has been a change in the number for the order of the pill so It is not ready just yet....so when they finally said the order was ready I went in to pick it up and (my fault to assume) that the order had been filled properly... on the outside of the bottle it said the brand name Avapro and nothing else... I can't take the generic as I am allergic to it... so I have been taking pills for about a week and half and started to develop dry cough and getting hives but it never occurred to me it was the HBP meds... so didn't think to check the actual pill since the appearance of the pill is similar to the brand name pill... I though I was getting sick from something else.... then two nights ago I had my "epiphany" moment and remembered 4 years ago when they tried me on the generic first I had this same reaction that I am having now.

So I get up and look at the actual pill and notice that the number is different from the one I normally take but by one digit... the same heart imprint on the other side... I get on the internet, I call the doctor and discover that Avapro generic is ibersartan which is what that filled the bottle with but labeled and made me pay for it as the brand name... Avapro brand as opposed to irbersartan which was the generic... to my knowledge if you put a generic in the bottle to fill you have to label it with the generic name... what they manipulated the label is put the brand name on the outside and then put the generic in the small writing on the back of the bottle... which to me is like a knock off... so I went to the pharmacy and one of the pharmacist was very condescending and belligerent about it and pulled out the bottle as it said irbersartan and in parentheses (Avapro) making like I was wrong and this was the actual brand name of the drug and showing me the bottle of the generic... very snotty about it... I took my bottle back, and don't know where to go or do but am now feeling really crummy and going to visit the doctor in the am... then I am going to go back to the pharmacy store manager and make a complaint.

What this pharmacist is doing is misrepresentation of what she is filling the bottle with and charging me brand name price for the generic form... I understand product labeling very well but if she is going to put half of one info and half of another and fill it with the knock off, that is illegal and also I might add dangerous.. just to cut a corner! and you are exactly right.. generic drugs are not the "identical" to the brand name.....

I myself have to go to the pharmacy to get my pills changed. I was switched from a generic time release hyoscyamine made by Paddock laboratories to one by Franklin pharmaceuticals and I noticed more pain, like the pills aren't working right, and I had the same reaction I had to a few OTC generic medications. I had figured out the problem with the OTC drugs were the binding ingredients, so I switched to the liquid caps and have been fine. I googled the ingredients of the new pill, and lo and behold, they were the same binding ingredients that I had trouble with on the OTC meds.

quack quack

After years of fighting with the recommended medications for fibromyalgia my physician started me on Oxycontin, as chronic acute pain is my most serious presenting complaint. I had gained over 100 pounds from all the antidepressants, and this was an amazing relief. I took 60mg O/C am/pm with 2 OxyIR for breakthrough. Over time with relief of pain I regained my life, lost almost all of the 100 pounds.

A divorce in 2009 left me without insurance. I tried but did not qualify for Purdue Patient Assistance, and since this name-brand extended release rx was now going to cost me almost $900/month, my doctor switched me to an equivalent amount of oxycodone. I found an online prescription assistance program and have paid cash since.

A move to a different state left me in the care of a new doctor and a new pharmacy. Without any problems, this pharmacy filled my rx every month with a generic that worked *almost* as good as the name-brand. Since I've taken this generic for so long I was used to the decrease and compensated.

About six months ago I began a journey to decrease the amount I was taking. With my doctor's blessing I started cutting tablets, increasing times between doses, and successfully got down to about 45% of the prescribed does.

Until last month.

The pharmacy where I have filled this prescription for years made a change in many of their generics based on corporate bottom line. Within three days I was taking full doses again and even that was not completely meeting the pain.

This month, with my doctor's approval, and the name of the pharmacist, who suggested I call around to make sure someone both took my rx plan and had a different generic, I spent nearly 7 hours on the phone. Sometimes I was met with suspicion (I'm a little old lady in my 60s, for Pete's sake!) and sometimes no one would talk to me. I kept at it until I found what I needed.

This month I'm back at it, working my way back down. Six months of progress was wiped out by one bad month of an inferior batch of a different generic (which, btw, that lovely pharmacist told me she's received numerous complaints about...)

Pain meds are tough because pain patients have to deal with doctors and pharmacists that not only have to cope with FDA, but the DEA as well. We often get treated as addicts, though I account for every single pill to my physician. They are often in fear of losing their licenses. It's ugly.

Nevertheless, it's pain and discomfort, not life-threatening danger that problems with some of the other medications can cause.

Thanks for keeping this line of communication open.

There are 2 drugs I must take BRAND NAME because the fillers in generic cancel the drug. It is like taking a sugar pill!

My husband and I have always had to fight with our insurance company over brand name medications. No matter how many medical reports we submit, they deny coverage. Now the problem is the pharmacies. Despite the fact that we have agreed to pay exorbitant prices for brand name medications, the pharmacies are now trying to take away our right to do that. They make more of a profit off of generic drugs. We have to speak to the manager each and every month to get our prescriptions filled with the brand name despite the fact that our doctor has indicated filled as prescribed. As long as health care and prescriptions are primarily about money rather than the health of the people, the people will suffer.


Have been recently prescribed Chemist brand Efforxor 150mgs. Took one yesterday and within an hour I felt sooooo sick! Heartburn and continual vomiting within an hour of taking this medication. I was shaking, red in the face and thought I was going to die! I will never take chemist brands again. I have been told that the red dye for the capsules is imported from China and so is the rest almost imported from overseas at cheap prices for Chemists in Australia and sold at Chemists own. Beware, pay the extra two dollars and you will feel better. Have not taken medication today and feel better

THE FDA will NOT do anything if we all don't complain every time we have a problems with a drug, especially if it came from China, India etc….

To me the biggest fraud is when generic companies are allowed to change the dispersal method of a pill and still call them equivalent. This was the problem with Wellbutrin XL. The Teva version of the 300mg didn't have the same plasticky coating that the others have, including other generics. The Teva pill was this huge pill that very obviously relied on the size of the pill to take time to release. I noticed almost immediately that the Tevas just didn't work, and I had to call all over god's green earth to find a generic version that did have the right coating. The Tevas were so much cheaper for the pharmacy to buy that eventually no one carried any other brand. The 150mg Tevas on the other hand DID have the right coating. So I got my prescriber to give me a script for 2 x 150mg.

I'm having the same problem with my husband's Concerta ER, and he noticed the very first day. He says it's not as bad as taking nothing but it's not nearly as good either. The first "generic" was actually a re-branding of the brand name, which was fantastic for us. But now, other companies have developed methylphenidate ER pills. The dispersal method is different on the new ones. They don't have the same coating! Again! I fail to see how these can be considered equivalent. If they're going to make a methylphenidate extended release with a different dispersal method they should be required to NOT call it generic for Concerta ER. And since I've learned from the Wellbutrin fiasco, I have called all over again looking for the original "generic". ONE pharmacy in the area carries it, because it's more expensive to stock. I bet everyone is surprised by that, huh?

My main point is that it took me a lot of phone calls and a lot of experience to figure this stuff out. How can we possibly expect everyone to be able to do what I managed to? Seniors who are starting to have memory problems? People who just plain don't know it's a possible problem? People who take 15 pills a day? People with 3 jobs who don't have the time to call 8 different pharmacies every time they get a refill?

It's disgusting, and I personally find it reprehensible that we allow the race to the bottom price to have priority over people's welfare.

I have been taking Dilantin since 1956. Once under control, I have not had a grand mal seizure since 1963. At one point while hospitalized I was given a generic which is "exactly the same as Dilantin". After a bad night but no seizure, the pharmacy "examined" the meds I had with me and allowed me to take them.

When I returned home, I called the Neurologist for an opinion. His reply was "The active ingredient may be the same, but it may have released at a different date in your system. Always ask for DAW and use the name brand!" (DAW is "Dispense as written - in other words NO GENERIC!

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?

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

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.

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.

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.

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