Anyone who knows me, knows that I’m inherently frugal. “Sale” is one of my favorite words. If there’s a less expensive alternative, I’m usually all about. But when it comes to medications, do you “get what you pay for?” The short answer is no. (For the record, I have NO financial relationships with any drug companies). Here’s the explanation:
A drug by any other name…
All drugs have 2 names: a trade name and a generic/scientific name. The two names exist regardless of whether a generic equivalent is available yet for purchase. Many of the generic/scientific names have similar endings to the name in order to identify the drug class. This helps identify what the drug is used for. Here’s some examples (looking at generic names). Antifungal drugs usually end in “-azole”-like miconazole, fluconazole, ticonazole, etc. Blood pressure drugs (specifically Beta blockers) end in “-olol”-propanolol, esmolol, nadolol, etc. Antbiotics in different classes end in “-floxacin”-ciprofloxacin, ofloxacin, levofloxacin, etc.
What’s the difference between a generic and trade name medication?
The trade name simply means the name brand. It’s the name the manufacturer came up with (after spending tons of money studying what names stick with people). The generic name is the scientific name of the medication. For example: “Tylenol” is the trade or brand name for the medication “acetaminophen.” Another example is “Motrin,” which is the trade name for “ibuprofen.” Only one company makes “Motrin” where many companies can have their version of “ibuprofen” (there is often a much cheaper store brand version of the generic). There are generic and trade name versions of everything. “Levi” and “True Religion” are brand names of jeans. “Kleenex” is a brand name for tissues. In medicine the active ingredients in generic vs. trade name medications are the same. The FDA regulates generic medications just like trade name ones. There are standards in terms of identity, strength, quality, purity, and potency. The slight differences fall in how they are manufactured (e.g., they may have different flavorings or forms: liquid vs. tablets). It is a rumor that large differences exist in the effectiveness of the two drugs. To get approved, manufacturers of generic medications have to prove a drug’s “bioequivalence.” This means that after someone takes a medication, the measured amount in the blood stream has to be the same for the tradename as the generic.
Why do medicines cost so much?
It blows me away sometimes how expensive medications are. Generally speaking, the cost of a medication reflects what went into the “R&D” (a.k.a., research and development). Highly technical drugs that may have had very lengthy and expensive research (e.g., cancer or immune medications) cost significantly more. The pharmaceutical company builds in all those costs to “bring a drug to market” (which includes things like the costs for previous failed attempts).
How long before a drug becomes generic?
In the pharmaceutical world, there are couple of factors that come into play. Patents last 20 years and can expire at anytime (regardless of the drug’s approval status). So if a drug took 10 ten years to get approved, it may only be 10 years on the market with a patent. Exclusivity applies once a drug is approved (and prevents competitor drugs). Exclusivity periods depend on the type issued and last anywhere from 3-7 years. This is why sometimes there isn’t a generic equivalent that can be prescribed.
Should I buy generic or trade name meds?
This is a matter of personal preference. The drug reps would not be happy with my answer here. For the frugal at heart, generic is generally more cost effective. Now there are always exceptions (e.g., coupon programs to make trade names cheaper, etc.), but as whole, generic is cheaper. From a medical standpoint, there is usually not much of a difference. In the case of the few exceptions (e.g., the mist of a trade name nasal spray may be finer than that of the generic), your doctor will/should be able to clarify.
What are the different “tiers” of medications?
In the world of insurance coverage and medications, there is a “tiered” program. Each insurance company contracts with the various drug companies to see at what price they can get the medication. The less-expensive drugs in each class are usually listed as “tier one” drugs. The medications get progressively more expensive as they move to “tier two” and then “tier three.” It’s to your advantage as a consumer to figure out which meds are on the tier one plan (especially if the medication is going to be taken regularly). For this reason, most generics are tier one medications. The insurance company will encourage you, the consumer, to use a cheaper medication by covering it better. Just remember, the lower the tier number, the lower the cost (tier one = less expensive).
Docs understand cost limitations
In my practice, I almost always write a generic equivalent medication when available. However, some docs don’t. Often docs learn medications by the trade names and just get in the habit of writing them over the years (even after a generic becomes available). I haven’t met a doctor yet who wouldn’t write the generic when requested by a patient. There is no shame in asking for a less expensive medication, so speak up. After all, who doesn’t want to save money?
