I am a pharmacist with 40 years of practice. I am very disturbed about the generic drugs that are coming into this country from who knows where. Unfortunately, we have little choice in choosing a generic or a brand name. This is dictated by the insurance company.

When your prescription is filled an electronic claim is sent to your insurance company. The drug is indentified by its national drug code (NDC) and if the insurance company does not like the drug that is submitted, they immediately reject the claim. The insurance company is the gate-keeper through their rejection process.

The FDA considers the country of origin to be confidential information. In many cases I cannot even tell where the drug was manufactured to advise patients. I find this outrageous. Every consumer has a right to know where his drugs are made. We need a consumer uprising over this. Contact your representative and make him aware of this travesty.

Len

Jan 23, 2011

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  1. RN
    Reply

    My concern is that, yes, the insurance companies can state they will pay for a generic medication, but they are choosing the manufacture: NDC # to approve or decline to pay. If you are on a generic that works, but then get new insurance (UHC/ Optium Rx) that will only pay for Dr. Reddy that does not work (generic Protonix) your option is $$$$ brand per month. Have on order the only other manufacture Camber’s NDC# they will pay for to try, fingers crossed ! Good web site to keep in mind on sensitivity of generic medication : https://www.peoplespharmacy.com/2009/05/25/generic-drug-re/

  2. Tonya F.
    United States
    Reply

    Thank you so much Dr. Graedon for posting this issue. I have been taking Imitrex and Maxalt since the late 90s, they worked perfectly every single time without a single side effect.

    A few years ago I was given the generic equivalent made by Dr. Reddy’s (India) and had the completely opposite experience. Not only did the Dr. Reddy’s version fail to even slightly alleviate my pain, this medication made me physically ill (horrible stomach acidity/nausea, overall malaise).

    I went to a different pharmacy next time and was given the equivalent made by Aurobindo (India). Not quite the intensity of side effects, but it simply failed to work.

    Finally, I was able to find an equivalent made outside of India, Teva (Israel) and it worked exactly as it should, thank goodness. This has just concerned me for several years however as I think of those whose reliance on a medication might be more dire, not simply the relief of a migraine.

    So when I heard rumblings of tainted Indian medications being the culprit in the recent events in India (mass sterilizations involving deaths) I took notice and would like to share this article:
    http://www.theguardian.com/world/2014/nov/14/india-sterilisation-deaths-rat-poison-linked-tests

  3. kath
    Reply

    I have been taking generic Imitrex (Sumatriptan), for good few years now and past year I experience horrible side effects like stomach pains, nausea, panic attacks, heart palpitations, lack of manual coordination (lasting more than 6 hours after taking that pill), and more to the point that I would be afraid to take my medication unless my headache became unbearable which happens often.
    Lately I started to evaluate when I get these side affects since I do remember times when I felt just fine after taking my pills. Just today I discovered that the medication that I took last time was manufactured in India and the one that did not affect me adversely was from NJ, USA!!!!
    And since I just refilled my new prescription, I had a look at the back label of these pills. Guess what!! INDIA, Dr Ready!!! I got furious – I called my (new) pharmacist and he ask me to come by… Will see if he take my meds back – if not I will call my TV station and post this on Facebook! Actually I should post it now – just to warn and inform other people who are being kept in dark. :(
    I do not support foreign economy when we can buy AMERICAN MADE products plus I do believe that third world made medication is inferior – I actually can attest to it from my experience with different medications. Years ago, I discover that not USA made antibiotics were not only less effective but they also would make my stomach sick to the point that I could not stay on them for more than two days!!

  4. D Strass
    Reply

    ML:
    I doubt it is the case that all medications state their country of origin on the package! Many of the generic drugs come from pharmaceutical companies that are in the business of marketing and distribution of drugs – third party sales – they never make the drugs themselves. They import them. The drugs can be manufactured (increasingly) in places such as India, Eastern Europe, China for cost reasons.
    A case to point is Actavis UK Ltd, a leading generic drug distributor. I am on Amlodipine 5mg and wanted to know where my medicine was manufactured. I contacted Actavis and asked where this generic drug sold under their label, was manufactured.
    They told me: “it is our company policy not to disclose the site of manufacture of our medicines as this is confidential company information.”
    So they don’t all say on their packaging the country of origin nor do they disclose it if you ask them. If we found that a medicine we had to take was manufactured in China, how many people would refuse it? That would be bad for business and for the profits being made by the drug industry.
    The fact that this information can be withheld from the consumer is, in my opinion, criminal but it is going to take the public to get mad and demand of their politicians that they will not be lied to and fobbed off when it comes to having information about where their drugs are manufactured and the right to choose not to purchase it if you don’t trust its origin. (Ditto the foods we put in our body).

  5. Vlad
    Reply

    Medicine is a serious matter of life or death and any responsible government shouldn’t just allow and accept that a generic equivalent is safe, and above suspicion.
    Government control over the importation and quality of generic medicine should far more strict than what is the case presently, not only for the USA, but all countries.

  6. Tom E.
    Reply

    IMPORTED generics? Why? Enough of America has been given away. Companies such as Pfizer, Lilly and others invest millions even billions in R&D of pharmaceutical products, with a limitation on the patents. When the patent becomes expired, other companies are permitted to market a generic of a patented product. Do you really want to subject our health to generics produced of unknown quality in countries that are financial and political adversaries of the USA?

  7. tps
    Reply

    so why aren’t drugs being manufacutred here? Our folks need jobs! Someone tell me if drugs made in India are safe! Who knows what is really in these drugs!!!!!!! My medicine would cost over two hundred if it was not generic! So frustrated over everything that is going on!!!!!!!!!!. We are all being had! Scary times my friends! Speak up and be heard!Can we trust these drugs made in other countries?

  8. DS
    Reply

    ML it is not true in the United Kingdom that a pharmacist can find out in which specific country a generic drug is manufactured by reading the leaflet or packaging inside. I believe this to be the case in the US as well. I was prescribed high blood pressure medicine which I will have to take the rest of my life and the for free NHS version is a generic drug. I visited several pharmacists and asked to see the brands they held of this generic drug. Pharmacists on the whole had no clue and were as surprised as I was to find that on the leaflets in the drug pack it did NOT tell which country the drug was manufactured in.
    I researched and got a list from MHRA (like FDA) of which companies either made or marketed the drug and emailed these companies. Some didn’t bother to answer the emails, one refused to say, stating that it was a trade secret, most were made in India but I found one manufacturer in Hungary and this it the brand I use. I am not happy to take medicines made in India because of quality control issues there and the fact that it is easier for Chinese-made counterfeit drugs to find their way into the Indian drug market than in other markets.
    But it is really a scandal for the FDA to say it is not necessary for patients to know in which country their drugs they ingest are made or to have any choice in the matter. The whole drug industry has a profound effect on people’s lives and to deny them the right to know where their medication actually comes from is criminal.

  9. Ccw
    Reply

    My pharmacy filled my generic script for femhrt with Jevantique, and now I am having night sweats I haven’t had in years. I did ok on jintelli…but I have a 90 day supply and will probably have to use it up before insurance will allow a new refill. :(

  10. RMA
    Reply

    I have taken Femhrt for some time. I was given Jinteli last time I filled my prescription. It was somewhat cheaper than Fmhrt so I didn’t question the switch. I have had several side effects with the Jinteli: breakthrough bleeding, acne, mental fog. I’ve used many generics and never had a problem. Anyone else out there with problems from Jinteli?

  11. SDC - Pharmacist
    Reply

    To DS:
    Nearly all of the deaths were due to errors (allergies, drug-drug interactions, etc.), NOT generic substitutions.
    It is only Russian Roulette if you buy drugs online (from uncertified vendors) or from street vendors in 3rd world countries – This goes for Brand and Generic.

  12. SDC - Pharmacist
    Reply

    First of all, the problem with imports is not the country/manufacturer of our drugs. The problem is that their are huge markets for counterfeit drugs. When you buy online from Canada, you are not getting drugs from Canada – they are most likely coming from a third-world country and are counterfeit (either no active, some active, or harmful substitutions, etc.)
    If you want Canadian drugs, you better drive to Canada and get them. Pharmacies buy their drugs through primary wholesalers who get these drugs through trusted manufacturers. Secondary wholesalers are risky, but are pretty much phased out. The moral of the story is do not buy drugs online.
    Also, none of these opinions are validated due to placebo effects. If you want good information, you must learn about evidence-based medicine. This is what they teach you in pharmacy school. For someone to say my brand worked better than my generic is meaningless, unless this information is determined through a double-blind experiment.
    Anybody can write anything on the internet, and most people are too lazy (or do not have access to) to filter through the primary literature (e.g., clinical studies). So what I am trying to say is you have to take everything you read on the internet with a grain of salt (including this statement).
    I am a bit of a purist and want to buy drugs made in the U.S. or Europe, but not for reasons of fear of bad quality generics. I just have an appreciation for innovator companies and like to buy the original of anything. Anyway, sorry to burst any bubbles… good luck out there people.

  13. DS
    Reply

    There may be a form your physician can fill out indicating that for you the brand medication is medically necessary. This may enable you to purchase the brand medication at the same price as you would pay for the brand medication where a generic is unavailable.
    From experience I would like to inform readers central nervous system medications should be limited to brand medication, the generic and the brand medication ARE NOT identical. The primary ingredient MAY be… but the compounds used to deliver the medication to the target sites may be totally different, thus effecting the efficacy of the medications. One medication of the five I must take to be normal is 100% ineffective, i.e. has no effect at all. Thus I must take the brand just to sleep at night and be functional for work. Also, the pharmacy techs try to save you money suggesting the generic but be very, very skeptical and first do your homework.
    It IS Russian roulette; more Americans died in 2009 from “pharmaceuticals” than automobile accidents. This is a first.
    Good luck… find out from your insurance company if there is a form your physician can complete on your behalf explaining your situation and requesting you be authorized to purchase the brand medication.
    Folks, it’s bad. Our medications and the food we buy in supermarkets can and have killed significant numbers of Americans.

  14. mjt
    Reply

    As a pharmacist for a large retail chain, I have no choice in selecting the line of generics stocked in my pharmacy. I do have a voice, however. I have commented to my company over generic manufacturers I have doubts about (Dr. Reddy – which we no longer use) and I always give a full, honest answer to any patient who wants to know the source of her medication.
    I don’t hesitate to provide patients with my thoughts on specific meds based on patient feedback (certain brands of risperidone and lisinopril, thyroid USP products) or to offer courses of action to those who are financially bullied by their insurance companies.
    One option I often suggest when someone finds that a generic does not “work as well” as the brand, especially when the effect is quantifiable (blood pressure, and depression for examples) is to work with their medical provider in adjusting their dose to again reach their treatment goal.
    Most of the time a difference in effect is due to a small (usually) difference in absorption or bioavailability and can be rectified by a small dose adjustment up or down – I have seen a generic produce a greater response than the brand, though it is usually the opposite.
    There are choices, and asking questions is the key to seeking them out. Also, to the responder above, don’t take the comments on a few products out of India personally. I would, however, have you read peer-reviewed journal article about worldwide counterfeit drugs and see the proven statistics about drug products in China, Russia and India. It will make you very angry, not in defense of those companies but in support of the populace who are hurt by them.

  15. FR
    Reply

    Interestingly as an agency nurse in local long term care facilities, there are some physicians who will not allow generic Coumadin to be utilized because the PT levels are so inconsistent. When questioned about this, they tell me that though this may not be true of all generic medications, name brand is particularly important for Coumadin.

  16. JulieMS
    Reply

    You can find the manufacturer of the generic drugs on this website, then you can search the manufacture and find out where they are located.
    http://www.drugs.com/imprints/

  17. JulieMS
    Reply

    I can’t afford brand name ambien. But the generic is leaving me with horrible hangover effects. Doctors wont’ address it, the pharmacists won’t report it to the insurance co., I doubt they really care. I also believe the generic antidepressants I take are not helping me or my son. The doctors just want to increase them and I’ve been down that road before to no avail.
    If there are so many people unsatisfied or having problems with Generic drugs, why isn’t the media contacted, to get this out there more? Will they wait till people die first? You, Joe and Terry Graedon need to be the voice for us who don’t have one. Please.

  18. Carol Anne
    Reply

    Over a year ago I was switched from Wellbutrin XL to a generic (bupropion?) without being asked. After 2-3 mo my family noticed I was acting strange, my husband said it was like just before I had a total breakdown 10 yrs ago and wondered what was wrong. Then we saw an article the next day.
    I called my Dr, she had me come in that day, switched me back to Wellbutrin XL, wrote DAW on it, called the insurance company to explain what happened, got the okay for the request. Within a few weeks I felt much better. From then on I have asked my Dr to write the DAW on the main psych drugs. I don’t like the generic for some of the drugs but they give me the choice of paying full price or generic discount… that leaves me with no choice but to take the co-pay.
    It is un-American to have to take drugs from who-knows-where and contain who-knows-what. What is wrong with the FDA that we are not allowed to know what we are consuming?

  19. mjs
    Reply

    March 22, 2011
    Hi,
    Had similar situation with CVS (substitute white for blue green). Also, insurance company refused to pay for Brand Name once generic cozaar hit the market. Called the doctor to ask that they write a letter to keep me on Brand Name. Sorry have paperwork at home, but essentially called the US manufacturer and found that the blue green were going to be substituted with a white and that was the manufacturers generic which they were weaning the general public to.
    Found that that generic was made in US. The next step was that the US generic would be manufactured in Slovenia and received that for one refill only; the next one was manufactured in India. A sort of roundabout way to arrive at what your side effects or symptoms were when you went to generic cozaar; have had ringing in ears since October (asked if meds might cause and, of course, the answer was no and if you would like us to we can go to another brand; why, I ask when I was doing so well on my little blue green pill?); so, long and short having an mri tomorrow to see what is causing the ringing. If it is a problem from the change in meds, how many prescriptions would the mri cover??
    mjs

  20. jf
    Reply

    This issue definitely needs to be brought to the forefront. The Teva pharmaceutical company is one that needs investigating, in my opinion. I took the three drugs below. The first name is the drug I was prescribed, the second drug is the one I was given at some point.In all three cases, when the pharmacy, without telling me, switched to the generic drug, I was able to tell within a week that something was not right.
    I took the Wellbrutin and Inderal to prevent migraines.The newest generic, Jinteli for Femhrt, was just switched last week. The two packages look so alike that I never noticed. That is until I started getting hot flashes and couldn’t sleep after about 5 days. I will be taking the Jintili back to get my Femhrt.
    Wellbrutin XL -Budeprion XL
    Femhrt-Jinteli
    Inderal-Propranolol

  21. JohnnyRebel
    Reply

    You are in error about your claim that US patent Law has been violated by CIPLA if “they” import meds that are protected by US patent Law.
    Meds that are manufactured in India (where the US patent laws are not observed regarding many of the products produced) are Internationally recognized as being “Legally Produced Pharma.” These Indian generics are not “pirated copies” or “counterfeits” that can be “legally confiscated” by customs agents; they are “legally produced reverse engineered products.”
    CIPLA is not the “importer” – they are the manufacturer.
    US citizens who buy their “generic meds” from India and have them imported are not in violation of any US laws; nor is the manufacturer, CIPLA. End of story.

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