I recently spent an hour talking about Lipitor with one of my close friends. She takes Lipitor for her cholesterol, but her pharmacist gave her Zocor instead. Initially, she thought her health insurance would not pay for the name brand drug and took Zocor for a short while. Her negative side effects brought her back to the doctor’s office and they found that her LDL cholesterol (the bad cholesterol) is high again. After a little investigation, she found out that her pharmacy made the executive decision to change her medication even though her health insurance will pay for the name brand drug.
Why would pharmacists substitute a prescribed drug with a generic?
Usually pharmacies substitute a prescribed drug because your health insurance refuses to pay for the brand name or more expensive drug because it is not listed on their plan formularies. If a doctor can prove that a particular drug is medically necessary, sometimes the health insurance might cover the brand name or more expensive drug. But the problem is the amount of time a doctor must spend to “prove that a particular drug is medically necessary” to health insurance company.
Another reason for the prescribed drug substitution is that you have a shady pharmacy. The drug manufacturers have a higher profit margin on name brand drugs, but the profit margin is higher on generics for pharmacies. Without a patent, any drug manufacturers can make generics, so a pharmacy can shop around for the cheapest generic on a particular drug.
But I thought generics are just as good as the name brand drugs?
It depends what you are taking the generics for. Sometimes the generics are in the same class of drugs as the name brand, but the difference is how they treat the medical condition.
For example, Lipitor is a cholesterol lowering statin that helps decrease my friend’s LDL cholesterol and triglycerides. But Zocor, though in the same family class of statin, is better for raising HDL cholesterol (the good cholesterol). Even though the ultimate goal of these drugs are to increase her good cholesterol in relation to her bad cholesterol, how they are design to achieve this end result is very different. And how her body reacts to these two drugs are also different.
What are the four most common generic drug substitutions at the pharmacy?
1. You might be prescribe Lipitor, but you might end up with Zocor for your cholesterol.
2. You might be prescribe Diovan, but you might end up with Zestril for your blood pressure.
3 You might be prescribe Nexium, but you might end up with Prilosec for heartburn.
4. You might be prescribe Lexapro, but you might end up with Celexa for depression.
How do I prevent a generic drug substitutions at the pharmacy?
1. Enroll the help of your doctor. Ask your doctor to write “may not substitute” or “medically necessary” on your prescription.
2. Before filling your prescription, ask your doctor if there are any generic drug substitutions that are acceptable for your health condition. Write down the names and check your doctor’s recommended generic drug substitutions with your pharmacist when you pick up your prescription.
3. Fill your drugs at a giant retailers such as Walmart or Target that cut their generic drug prices. Generics are a lost leaders at these retailers to get you to shop for other items at their stores. So they have a no incentive to substitute your name brand drug with a generic substitution.
4. Stick with the same pharmacy. Not only will your pharmacy recognize if a drug will work for you, filling your prescriptions at the same pharmacy is a smart move because your pharmacist is the last checkpoint before you take your drugs home, potentially spotting any fatal drug interaction before it occurs.
5. When your pharmacist said that your drug is no longer part of your health insurance formulary, call your health insurance to verify.
Until next time and thanks for stopping by.
Photo 1 by: Amanda M Hatfield.
Photo 2 by: Lee Nachtigall.
- Are Generic Drugs As Effective and Safe as Brand Name Drugs?
- Prescription Medication: Why Doctors Prescribed What They Do
- Reduced or Free Maintenance Medication for Chronic Health Conditions
- How to Reduce the Cost of Prescription Drugs
- Reduce the Cost of Medicine with Pill Splitting
- Getting Health Care Without Health Insurance
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{ 2 comments… read them below or add one }
That’s really fascinating. Part of the reason why I try to steer clear of drugs as much as possible!
.-= Sagan´s last blog ..Attention Living Healthy in the Real World Readers! =-.
Sagan – Maybe there is less emphasis on profit in your neck of the woods?