by Stewart B. segal, MD
BRAND VS GENERIC
As the economy worsens and insurance companies tighten their strangle hold on my patients, I am regularly confronted with demands to change from a branded medication, on which my patient is stable, to a generic equivalent, or worse, to a totally different class of medication. In one of my children’s favorite books, “King Bidgood’s in the Bathtub” by Audrey Wood, one of the characters laments “Oh, what to do, what to do”. I feel like that character, uncertain as to what to do.
Generic medications are the result of brand name parducts whose patent has run out. Once cutting edge products, they were initially introduced to the market many years earlier, they were “branded” and possessed major advantages over the older, then “generic” medications. As time passed, new and improved medications showed up on the market, replacing the older, now less valuable pills. This process of new becoming old and cutting edge becoming less useful is the natural life cycle of the pharmaceutical world. As an example, take a group of anti-hypertensives called “A.C.E.s”, such as lisinopril. When lisinopril first hit the market, it became one of the most prescribed medications for hypertension. It possessed many advantages over older therapeutics with only two major drawbacks. Lisinopril made people cough and it had to be taken twice daily. Patients hate coughing and can’t seem to get the knack of taking something twice daily. The companies that made “A.C.E.s’ went back to the drawing board and came up with the next generation of miracle pills called “A.R.B.s”. “A.R.B.s”, such as valsartan, rarely caused cough and could be taken once a day. “A.R.B.s” are stronger antihypertensive medications and have added advantages and, therefore, added value. “A.R.B.s” (still branded) replaced “A.C.E.s”, which are now generics.
“Oh, what to do!” My patient expects to be on the best treatment modern science has to offer. They want a safe, effective medication that is taken once a day and has no side effects. I want my patient to be both happy and healthy. I prescribe the medications that are most likely to help my patient and I achieve success. In time, my patients and I find the best treatment for their individual needs. Customizing treatment plans is not easy; and once we have a treatment plan that is working, changing that plan is insane.
Enter the insurance company and its lust for profits. Add a bad economy and financially strapped patients, and you have the formula for disaster. Ever hear of not rocking the boat? I hate to rock the boat once it is on calm water. When my patient is doing well, his disease well controlled, his labs normal and he is happy, changing medications is potentially dangerous and foolhardy. So, what do we do?
If the cost of therapy is prohibitive, then a switch to a generic becomes mandatory. However, it is not that simple. Often, the upfront savings at the pharmacy is offset by the increased expense of the added office visits and testing necessary to develop and balance the new treatment plan. If side effects become an issue, it may take months to find an alternative. While we are working at finding an appropriate, safe and side effect free protocol, we may lose control of the underlying disease we are treating.
If the insurance company is forcing a medication change, then it is time to fight. Today I saw a patient whose company had recently switched pharmacy benefits managers (insurance company) and whose new insurer insisted that he change all of his medications. Not only would those medication changes been dangerous, they would have been financially costly and time consuming as he would have needed to be seen in the office frequently as we adjusted his new treatment regimen. He went through his employer and fought his insurer’s callused decision and won.
Ultimately, it is the patient who must decide what his/her health is worth. As your physician, it is my job to give you the knowledge you need to choose the option that best fits your philosophy and lot in life. Weigh the benefits, risks and cost carefully. It may be your life that you save.