Told ya I’d get hate mail

There seems to be a common theme among my hate mail:

well. You’ve hit my hot button.
There are people who are allergic to generic drugs Not the active
ingredient but the binders dye, glycerin, etc.
So are you going to stop counting pills and make up generics yourself?

Hate to break it to you, but 75-90% of the oral tablets are made up of the same binders. The only difference might be the dye, but how many generic lisinoprils are there? How many generic metformins are there? How many generic drug companies are there that all make the same product (Watson, Teva, QT, Endo, Ranbaxy, Roxane, Upsher, etc). If someone has a true allergy to a “binder”, then most likely they are going to have a problem with the trade name medication. Getting an “upset stomach with everything except brand name” sounds pretty psychosomatic to me.

did you ever stop to think about the patients who have trouble with certain
generics? Please don’t give that crap about how all generics are the same
as brand name. We in the medical community know that some generics don’t
work as well. It’s a good thing you aren’t running the world because if
you were someone would have already shot you.

Problems such as with the binders? The same binders that all other tablet manufacturers use? Plain (non XR/ER) tablet making really isnt rocket science. They all pretty much are done the same way for the lowest dollar. Clinically, how would you determine if a generic isn’t working as well as a brand name? Maybe the patient skipped days (you dont know that, you dont have their refill records). Maybe the patient doesn’t take his/her medication just so they can get you to write a DAW-1 on their next Rx. With the exception of drugs with a narrow therapeutic index, how can you really tell that Lisinopril isnt doing its job (or the patient just wants trade name and refuses to take the generic). If you find a generic that doesnt agree with the patient for some reason, switch to another one by another company. When it comes right down to it, and the cards are laid out on the table, the reasons why generics “dont work” is because “the doctor said so” (fueled by drug rep kickbacks) or purely psychosomatic reasons. Ive seen it with every single brand -> generic switch to date.
Amazing how generics magically work when insurance companies stop paying for the brand name and the patient is slapped with a $300 bill for the trade name medication they so eagerly bitch for.

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24 Comments

  1. pinky says:

    “Mad_Doctor”, who made the second comment up there, is an idiot. I really REALLY hope he’s not really a doc.
    It has been proven, OVER AND OVER that generic drugs are not only “just as good” as brand name, but also that when there are failures (such as with dissolving issues) that the generic is often much better than the goddamn brand name. Simple.
    http://www.worstpills.org/public/page.cfm?op_id=47
    http://www.fda.gov/fdac/features/2005/505_save.html
    http://www.fda.gov/cder/consumerinfo/generic_text.htm
    Etc. etc.

  2. J-chan says:

    People demand brand-name drugs? Good lord, I have to specifically ask my psychiatrist and my GP to write me for generics, because my insurance won’t cover brand-names unless there isn’t a generic. o.o That “DAW” box means I end up with a $500-$600 medication bill for the month, instead of a $10-15 bill. That’s almost as much as my rent!
    Who can afford the extra cost? Drugs are expensive! Generics have always worked fine in my family and we have drug allergies out the wazoo. Hell, I have to carry a list of my prescriptions, my allergies, and my medical conditions in my wallet in case I ever end up in a hospital so they don’t accidently kill me. O.o

  3. FDPharmD says:

    Dude, don’t you know that the only ones that work are the generic vicodin’s that have the 349 on them! Or only the Endocet works, not that Oxycodone/APAP crap. I hear it all day!
    I have one guy and his wife who only want brand name…Valium, Paxil, Allegra. Doctor wrote her a prescription for Bacrim DS, and she wanted me to order in the Brand name! I told her NO, they dont even make it anymore! Then 2 weeks later she had some N/V problems and wanted brand name only compazine (doc even wrote it that way). I called an yelled at him :) that is not on the market and it has not been for quite some time.
    If patient wants brand name it is DAW 2, not DAW 1, dont defraud the system….silly physicians

  4. Ticked off Tech. says:

    Forget the hate mail. Psychosomatic is the key word there. It’s in there heads. I am sorry but people are ridiculous. Don’t tell me you can’t take a generic because it makes you sick. Especially if you have the nerve to complain about the price of medicines. I especially love the people who pay fifty dollars for a five hundred dollar medication and have the nerve to say that insurances make people pay to much. You ever here the phrase, “i’m in the wrong business.” Mostly used after someone pays 40 or more dollars for a medication. People make profit off of things they create. It’s a known fact. So if a manufacturer is willing to put a lot of money into studies they need to compensate themselves. Just be happy there is insurance. Oh wait, that doesn’t help. You still complain about high copays and stupid stuff like that. One more thing. If you have insurance, please get a copy of the details on your plan. This way you don’t bitch at the pharmacy when your prescription is $100 the first of the year. Yeah you have a deductible. Get this you have to pay it at the beginning of every year. Oh wow. That’s pretty darn amazing. Just a few more thoughts I decided to drop in.

  5. echodoc says:

    Amazing fact – most of us Docs use generics for ourselves and our families.
    If there were a huge problem with them, why would we do that?
    Good luck with Humana.

  6. I can to some extent understand the reason some people want branded drugs in a country that allows direct to consumer advertising. But at least they have to pay the difference. In the UK we have no DTC, but still some people insist on the brand, which they don’t have to pay any extra for. I just laugh when people ask for Zocor and their script says simvastatin. I get angry when the doctor changes it to Zocor for them (no generic substitution allowed), because its my tax paying for it.
    What makes me laugh is when someone just has to has a specific generic – oh, my metformin must be from Teva (but I don’t give a crap about my aspirin, simvastatin, bendroflumethiazide or amlodipine!).

  7. Carol says:

    I, as a consumer, am constantly amazed at the arguments I hear people start while I am standing behind them at my pharmacy counter waiting to be helped. I want to tell them “Go away. Come back when you aren’t stupid. The pharmacist is NOT going to give you more Vicodin just because you (ha!) ran out early.”
    On the other hand, I ask for generics for all scripts except Synthroid. That one I only take the brand name and yes I pay a higher co-pay. But that’s my choice so I expect to pay more.

  8. Cathy says:

    Well I take alot of generics, most of my meds are generics. But, there are a couple of things I don’t agree with.
    I had been taking Lisinopril for quite a while. All of a sudden my ins stopped covering it. I wondered why this was so because I thought it was a generic? I checked in the new book they had sent and sure enough it wasn’t in there. But, what was in there that was covered was Allegra and Zyrtec. Aren’t both of those brand name drugs? I now take zyrtec because they pay for it. Are they nuts to discontinue a generic but cover brand names?
    Also, I had taken hyzaar for a long time for HBP. Ins stopped covering it, i was changed to Lisinop-HCTZ. I developed the worse dry cough imaginable. This was not psyco anything. It was quite real. By the time I had an appointment with my Dr. I also had extreme SOB along with the cough. He said staraight away it was the Lisinop-HCTZ causing it. He contacted the ins and they covered my hyzaar and soon my cough and SOB went away.
    I had no problem whatsoever taking the generic but I couldn’t take it so what do you say about that?

  9. MLO says:

    Um… Sorry, but that wasn’t hate mail about allergy. Most people with problems with fillers spend a lot of time looking for a specific drug that doesn’t have that filler – like it uses tapioca starch instead of cornstarch. Or, they pay OUT OF POCKET to have their drugs compounded.
    Yep, there are a few folks out here who do need to have drugs compounded due to the pharmaceuticals insistence on ‘factory’ drugs vs. personalized drugs.
    Personally, I hope the big drug companies go out of business and pharmacists go back to actually creating compounds specific to a given patient. What a concept? A pharmacist doing what he was trained to do!
    Pax,
    MLO

  10. stuart says:

    As a member of the “medical community” (and, hey aren’t pharmacists part of that as well anyhow????) some of know generics DO work just fine thank you. In fact, even with narrow therapeutic index drugs e.g. warfarin, they are fine so long as it’s the SAME generic manufacturer with each prescription. I’ve even taken to explaining optical isomers to patients so they can see why omeprazole is ok instead of Nexium, citalopram instead of Lexapro, and so on.

  11. Weird, I have the exact opposite problem. Body can’t process Allegra but the generic version works wonders.

  12. Adam says:

    The only problems I’ve ever had with generics is that they taste different. And then it came to me: “Aren’t you putting those suppositories in the wrong end?”
    Problem solved.

  13. It does depend on what exactly the difference in ingredients is.
    For instance, brand-name infants’ Ibuprofen does not contain corn derived ingredients, but the generics generally do cotnain corn.
    Since we’re dealing with a corn allergy here, it matters to us which we get. One will cause an allergic reaction and the other won’t.

  14. Kristen says:

    hahaha!!! this is hilarious, people are seriously soo stupid! every time a patient comes in complaining that they want brand, i warn them it will be more expensive. they say it’s not a problem, and as soon as i come back with a new label they start freaking out about the price and want the generic again! we live in such a materialistic society… they are even obsessed with their medication being BRAND name! i say, shut up and take what im giving you… im going to school for this, you haven’t, so stop acting like you know anything on the subject matter!! one lady even claimed that the SECOND she put generic synthroid in her mouth, she would pass out… she said it happened a couple of times, and now she refuses to get any generics. yup, the SECOND it touched her lips she would pass out! hahaha – wow, i hate people! ok im done venting!

  15. becca says:

    Ahhh pharmacists, we are the most MIStrusted, Abused, Disrespcted, Shit-on profession. I think my customers react better to the sub shop guy telling them it will be 10-15 minutes to whip up their sub, then it is for me to “whip up” their life saving drugs. What do we know about drugs anyway? The doctors and nurses and even their receptionist know more than the pharmacist (rolling of my eyes-cut us a break!!!)

  16. pharmd/rph/why says:

    To Cathy:
    You’ve just illustrated the point brought forward by this blog. Simply because a medication is generic or brand has little (and most times nothing) to do with it’s pharmacologic properties. Yes lisinopril is a generic. Yes Hyzaar is a name brand. But the two have different mechanisms of action, and thus are catagorized differently. Lisinopril is classified as an ACE inhibitor (Angiotensin Converting Enzyme inhibitor). Hyzaar is is name brand combination product of HCTZ and losartan. Losartan is NOT an ACE inhibitor, it’s an Angiotensin II receptor blocker (i.e. slightly different mechanism of action than an ACE inhibitor).
    Lisinopril, and all other ACE inhibitors, are known to have a small change of causing dry cough, which apparently you had. Study after study have proven the long-term benefit of taking ACE inhibitors. Dry cough is bothersome, but in and of itself not enough to prescribe a name brand product such as Hyzaar to EVERYONE if they have not displayed dry cough while taking ACE inhibitors. Losartan is used an alternative for people like yourself that have this dry cough. It comes with a much higher price tag than lisinopril, and NOT the same PROVEN benefits in patients with CHF (congestive heart failure), although it may be similiar in terms of mortality benefits (still in question).
    In summary, Hyzaar did not give you any benefits because it’s a name brand and lisinopril is a generic. It gave you benefits because it’s a different medication, with different pharmacologic properties. It is an ALTERNATIVE agent to an ACE inhibitor for high blood pressure/CHF. This is why your insurance doesn’t cover this agent initially. You have to show that you can not tolerate an ACE (i.e. dry cough), before getting the more expensive agent.

  17. kathy says:

    all day long i ask customers if they want the less expensive brand medication, and all day long the answer is, i only want the real brand.
    or only if it works, or only if its the same. if it was different i couldn’t give it to you. if it was something else then it wouldn’t be the same. so when they say i want the real one, i say so your sure you don’t want the pretend one.
    all day long this goes on.
    obviously the public knows more than we give them credit for. i so enjoy reading your stories. i so identify with your comments, and i thought i was alone.

  18. MARTY says:

    I would just like to leave a comment about how if our wholesaler has a price increase, then we get paid by insurance for the old price (sometimes losing money on an RX). We called several ins. companies and they said they only update their prices once a month, so they pay at the old price(which may be weeks)until their once a month update. Seems like something legal could be done about this.
    Thanks!!

  19. John says:

    Yeah, “generic drugs don’t work for me.” Makes as much sense as “anyone named Bill, I don’t like!” What, your name is Bil? We’re just not gonna get along. I have a patient that had some weird reaction that landed her in the ER like 25 years ago. Apparently the ER doc told her she probably had a reaction to a generic drug she took! I’d like to strangle that idiot!

  20. StephRx says:

    Why, you’ve just addressed my favorite pet peeve. I have noticed a LOT that brand narcotics “work better” (fetch more $ on the street) than generic pills, AND they work better for industrial injuries, but not cancer pain. It is WEIRD. I love when the generic is MADE ON THE SAME FREAKIN’ LINE as the brand, but the patient has to have brand. I love it when welfare patients pay for brand out of pocket. Especially when they do this on their way to Hawaii. I wish I could afford to go to Hawaii.

  21. Okay, I know this was posted ages ago, but going to comment anyway…I agree 100% with everything you’ve said. When customers at our pharmacy ask for brand name they don’t even give reasons for it like the ones you’ve posted above – they just say they want the ‘real’ one. Yeah, because the generic cephalexin I’m offering you is just fake medication that we dispense to people we don’t like for lulz…damn, you caught me in the act…And don’t even get me started on generic Lipitor – even when I tell them it’s made by the same company they still insist on the ‘real’ one…

  22. Eva says:

    Well, I’m not a medical professional, but I do notice some generics/name brands do act differently for me. I take Xanax — don’t feel much different between generic and brand. I used to take Zyban/Wellbutrin – neither helped me mentally — but Zyban totally curbed my smoking, where Wellbutrin did nothing. I am not someone who cares if it’s brand or generic, unless there is something I myself experience differently. Why would one generic affect me differently and another not? I believe the person who commented on the compounds and binders. I don’t know anything about why or how, but I do know in some cases I do experience a difference, while with others, they are just fine.

  23. BG Pharma says:

    TAP,
    I don’t wanna scare you, but you may be wrong on this one.
    I’m a last year pharmacy student, go to a pharmacy to work, blah blah.
    So we have that Sopharma thingy that poops out generic Paracetamol.
    Last week in (on?at?) Technology of Drug Forms workshop we decided to test good old Panadol against Sopharma Paracetamol. Basic dissolution test, fake bowels juice (phosphate buffer), paddle machine.
    Well, guess what the results were. Panadol started pumping out paracetamol like there’s no tomorrow. In 5 minutes it released more than 60% of the 500 mg. In 30 min. 487 mg. out of 500 were released and the tablet had almost dissolved.
    Generic? In 30 min. it released about 83% paracetamol, which barely covered the criteria. And this is in perfect sink conditions – I don’t wanna know what may happen in the gut.
    I always try to find the best drug to give my patients, and given the poor state of my beloved home land, I thought the best was… hey, the cheapest. Not so fast. Now I give people Panadol instead of the cheaper generic.
    So, it’s not like we don’t have regulations, you know, but next time a patient complains of something not working or giving them shit, you may want to send it to a medical university to make some basics tests. Cause, ya know, some generics fail the basics!

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