Is There Even a Debate About Generic Drugs Anymore?

Just a few years ago people seemed to despise generic medications.

The simple mention of a generic would prompt my patients to draw back, indignant that I would even suggest what they considered to be inferior treatment.

How times have changed.

Today I can barely finish typing a prescription (we don’t write them anymore, you know) before the recipient asks, “That’s a generic, isn’t it?” 

In my area the tide shifted dramatically when a major insurer temporarily eliminated co-pays for generics.  It is one thing to save a few bucks at the pharmacy, but the prospect of “free” won over even the most wary of medical consumers.  Even for others, the cost savings of generics is often too great to pass up.

Yet, suspicion still lurks in the shadows.  Many people who have switched to generics for cost savings still believe that they are taking second-rate medications.

Are their concerns justified?

Critics cite the fact that a generic is not an exact duplicate of the parent drug, which is true.  Although the active ingredient is the same, there is allowance for some variability in dosage, as well as fillers and dyes.

Is this disparity of great concern?  It depends on the situation.

[Analogy enter stage left.]

Like everyone else, I must visit a gas station every week or so.  I know very well that premium gasoline is the best for my car (at least that’s what they tell me.)  However, I always fill up with “regular.”  Why?  Well, it adequately propels my car to where I need it to go, and has yet to cause any obvious problem.  I reason that switching to premium gasoline would not improve my situation enough to justify the extra expense.

Similarly, the variations between generics and their name brand counterparts are small enough to make little difference in most situations, but there are possible exceptions.

  • Drugs with a narrow therapeutic window (doctor speak for medications that can be ineffective or have adverse effects with minor changes in dosage.)  A clue that this might apply would be the need for periodic blood tests to measure levels of a drug.
  • Situations with dire consequences should dosing be inappropriate.  Blood thinners and anti-seizure medications can fall in this category.
  • People who notice side effects or lack of benefit upon switching to a generic.  This is often unrecognized today, since people often try generics from the start.
  • Unexplained variations in benefit/effect from month to month.

In the absence of the above scenarios, most people do just fine saving money by taking generics.

Of course, everyone has the option of insisting on name brand medications, just like they can pay for “premium” at the pump.

Stephen Meyers, MD

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