# Why would doctor refuse to prescribe generic Rx?



## DYI hunting (Feb 4, 2010)

My wife has had to deal with horrible cluster headaches for 12 years.  We went to Emory yesterday and the neurologist prescribed her Topamax and Imitrex injectable.  So we went to get them filled and combined they were over $500!!!  Our insurance doesn't cover prescriptions so she asked the pharmacy to substitute generics but the doctor had marked "no generics" on the prescription.  My wife called the doctor's nurse who said the doctor will not prescribe generics because they are not as effective.  Even after pleading with them about the cost, the doctor refused to prescribe generics?  This is ridiculous, the generics are less than half the cost of the name-brand.

Do doctors get gifts or kick-backs from the drug companies for prescribing specific brand meds?


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## boneboy96 (Feb 4, 2010)

I'm not sure about that...but the whole medical/pharmacutical industry seems to be a big money bucket.


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## Davans (Feb 4, 2010)

I'd find me a new Doctor.


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## jonkayak (Feb 4, 2010)

Call the drug manufactures as most of them now have programs set up to add you in the cost of their meds.


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## Twenty five ought six (Feb 4, 2010)

There has been some concern about some generics not being as effective as the name brands. 

BUT if the doctor could not point me to some articles about those specific drugs, I'd be finding me a new doctor.

Doctors get stroked and paid off by drug salesmen just like politicians do by lobbyists.

To answer the OP's question, Dr's get gifts and "honorariums" for prescribing name brand drugs.


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## jonkayak (Feb 4, 2010)

I don't know you so I'm not sure if you will qualify or not but these links might help out. Try googling patient assistance program and also try adding the name of the med to the front of the google search or the name of the meds manufacturer. 

Here's the link to the Topamax manufacturer's RX assistance program.

http://www.ortho-mcneil.com/ortho-mcneil/company_pap.html


Here is the other link for the Imitrex injectable. 

http://www.gskforyou.com/

Good luck and i hope your wife gets to feeling better.


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## NOYDB (Feb 4, 2010)

If there are Generics available then the drug has been out and in use for years. In a majority of the cases the generics are just that. However, there are some that for whatever reason, don't perform as well as the brand formulation. Some Thyroid medications are that way. Google the meds and see if there are reports of problems with the generics. If so talk to your Dr. about alternatives. If no reported problems with the generics, get another Dr.


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## Jeff Phillips (Feb 4, 2010)

I had cluster headaches for 8 years in my 30's.

I would have paid $500 to get over 1 of those things!

Hopefully your wife's will go away like mine did


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## DYI hunting (Feb 4, 2010)

We probably don't qualify for their RX assistance programs.  I don't mind paying an arm and a leg for name brand meds when there is no alternative, but they have generics of both of the meds.  It just drives me crazy because my wife now has to go back to her usual family doctor and ask him to prescribe the generic version of the meds the high cost speciality doctor prescribed.  The doctor seemed unfazed by the fact the name brands he was prescribing were almost $300 more than generic.


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## snookdoctor (Feb 4, 2010)

Next time you are in the doctors office, notice the number of well dressed young men and women carrying satchels that check with the receptionist and then walk in without waiting long if at all. You may not see them, as sometimes they have a separate entrance.

These are the pharmaceutical reps, sometimes 12-15 a day,  that are pushing their company's drugs and trying to build a relationship with the doctor so he will prescribe their product. Brand name drugs. They don't push generics.  

If there is a generic available and your doctor refuses to prescribe it without explaining the reason to you, maybe you should find a doctor that places more interest in your well being over that of his pill company reps.


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## DYI hunting (Feb 4, 2010)

snookdoctor said:


> If there is a generic available and your doctor refuses to prescribe it without explaining the reason to you, maybe you should find a doctor that places more interest in your well being over that of his pill company reps.



Emory comes so highly recommended and we were refered by our family doctor.  The Emory doctor is trying the same meds that our local neurology clinic prescribed years ago, just at higher doses and refuses generics.  

And yes, I saw two of those fine dressed men in suits and satchels check in with the nurse and walk straight back to the doctor area.  I knew that happened but never saw a doctor that would flat refuse generics.  

Wife is so mad she refuses to call Emory again and is going back to a local neurologist which happens to cost a heck of a lot less than Emory.


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## Throwback (Feb 4, 2010)

My wife's dr at emory makes it a point to FIND generic drugs for her. 

T


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## GoldDot40 (Feb 4, 2010)

DYI hunting said:


> Emory comes so highly recommended and we were refered by our family doctor.  The Emory doctor is trying the same meds that our local neurology clinic prescribed years ago, just at higher doses and refuses generics.
> 
> And yes, I saw two of those fine dressed men in suits and satchels check in with the nurse and walk straight back to the doctor area.  I knew that happened but never saw a doctor that would flat refuse generics.
> 
> Wife is so mad she refuses to call Emory again and is going back to a local neurologist which happens to cost a heck of a lot less than Emory.


But....What happens "IF/WHEN" the generics truly don't relieve her symptoms???? You will have paid (wasted)$200 on those and then turn around and have to fork out the extra $500 for the potent stuff.

Not saying the generics won't work.....I really hope they do/will for her. My sister-in-law was going through the same thing (cluster headaches) and she found that the generic Rx didn't help her much at all. The name brand gave her a good bit of relief.


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## DYI hunting (Feb 4, 2010)

Bassquatch said:


> But....What happens "IF/WHEN" the generics truly don't relieve her symptoms???? You will have paid (wasted)$200 on those and then turn around and have to fork out the extra $500 for the potent stuff.
> 
> Not saying the generics won't work.....I really hope they do/will for her. My sister-in-law was going through the same thing (cluster headaches) and she found that the generic Rx didn't help her much at all. The name brand gave her a good bit of relief.



This is not just $572 for one prescription, this is the cost of a months worth.  $300 extra a month is almost a car payment.


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## dbodkin (Feb 4, 2010)

Watch the topamax... My wife took it and she was a "Dope-a-Max" She became a total zombie


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## dawg2 (Feb 4, 2010)

DYI hunting said:


> My wife has had to deal with horrible cluster headaches for 12 years.  We went to Emory yesterday and the neurologist prescribed her Topamax and Imitrex injectable.  So we went to get them filled and combined they were over $500!!!  Our insurance doesn't cover prescriptions so she asked the pharmacy to substitute generics but the doctor had marked "no generics" on the prescription.  My wife called the doctor's nurse who said the doctor will not prescribe generics because they are not as effective.  Even after pleading with them about the cost, the doctor refused to prescribe generics?  This is ridiculous, the generics are less than half the cost of the name-brand.
> 
> Do doctors get gifts or kick-backs from the drug companies for prescribing specific brand meds?



Generics can vary up to 20% in their ingredients.  Many people have complained the generics do not work for them.  My guess is he is going by patients feedback.


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## buckstone0505 (Feb 4, 2010)

the answer is Yes


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## Bow Only (Feb 5, 2010)

DYI hunting said:


> My wife has had to deal with horrible cluster headaches for 12 years.  We went to Emory yesterday and the neurologist prescribed her Topamax and Imitrex injectable.  So we went to get them filled and combined they were over $500!!!  Our insurance doesn't cover prescriptions so she asked the pharmacy to substitute generics but the doctor had marked "no generics" on the prescription.  My wife called the doctor's nurse who said the doctor will not prescribe generics because they are not as effective.  Even after pleading with them about the cost, the doctor refused to prescribe generics?  This is ridiculous, the generics are less than half the cost of the name-brand.
> 
> Do doctors get gifts or kick-backs from the drug companies for prescribing specific brand meds?




Doctors don't get specific kickbacks, but he might own shares of Ortho-McNeil.  I would imagine he is basing his decision on patient feedback.  I would explain to him that you are willing to try the generics because of the cost difference and if the generics were not effective, you would go to the brand medication.  If he is unwilling to let you try, then I would switch physicians.  There is a lot of incorrect information in this thread.

Shop around, you can get generic Imitrex for a decent price.  It costs the pharmacy just over $5 for a box of 9.   There's a good mark up on that one.  Generic Topamax is the same, big mark up because of the brand price.  It costs less than $50 for a 60 ct bottle in 100mg.  Both together could retail for under $150.

Has she had a sleep deprived EEG and a MRI?


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## DYI hunting (Feb 5, 2010)

Bow Only said:


> Shop around, you can get generic Imitrex for a decent price.  It costs the pharmacy just over $5 for a box of 9.   There's a good mark up on that one.  Generic Topamax is the same, big mark up because of the brand price.  It costs less than $50 for a 60 ct bottle in 100mg.  Both together could retail for under $150.
> 
> Has she had a sleep deprived EEG and a MRI?



He wanted to try Imitrex injectables because she had little or no relief from the pills.  The auto-injectors are much more expensive, the generic are a fair amount cheaper.

She has had a PET, couple EEG's and several MRI's.  The last was while she watched a TV screen and they monitored her brain activity while different things showed on the screen.  She has a been diagnosed with one of two headaches, Chronic paroxysmal hemicrania or some kind of cluster headache that the name excapes me right now.  Both are difficult to treat and she has not responded to well to any of the treatments.


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## No. GA. Mt. Man (Feb 5, 2010)

I always thought they were the same but my brother in law has a heart drug that costs $$$$$ and he asked about a Generic and was told some were the same but some varied in their ingredients and his was one of them. I guess they just try to get close like Coke & Bubba Cola.


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## Bow Only (Feb 5, 2010)

DYI hunting said:


> He wanted to try Imitrex injectables because she had little or no relief from the pills.  The auto-injectors are much more expensive, the generic are a fair amount cheaper.
> 
> She has had a PET, couple EEG's and several MRI's.  The last was while she watched a TV screen and they monitored her brain activity while different things showed on the screen.  She has a been diagnosed with one of two headaches, Chronic paroxysmal hemicrania or some kind of cluster headache that the name excapes me right now.  Both are difficult to treat and she has not responded to well to any of the treatments.



I'll check on the injectable price to see what kind of deal you might be able to get.  I guess she has tried Indomethacin?
Difficult to treat CPH.


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## Doyle (Feb 5, 2010)

> Generics can vary up to 20% in their ingredients. Many people have complained the generics do not work for them. My guess is he is going by patients feedback.



Yep. My gastrointerologist will prescribe generics for lots of things but one that he will not allow is a generic for Prilosec.  He said that for that one, the generics simply don't work.


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## Bow Only (Feb 5, 2010)

Doyle said:


> Yep. My gastrointerologist will prescribe generics for lots of things but one that he will not allow is a generic for Prilosec.  He said that for that one, the generics simply don't work.



The 20% variance that was quoted was incorrect.  As for Prilosec, I don't know of a pharmacy that carries the brand.


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## Doc_5729 (Feb 5, 2010)

My wife takes two prescriptions just to survive. These meds are rather expensive and even with insurance the Co-pays are ridiculous.

When we asked about "generic's" to lower our out of pocket expense, the answer was NO!!!!

The reasons given were "not as effective" and "doses weren't clinically reliable". 

The "mg" per dose varies too much. Could be off by up to 20%.


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## Inthegarge (Feb 5, 2010)

Let's see the FDA approves Brand Name medications and "generic" medications. So they are allowing companies to sell medications that are not really the medications ??? The reality is the "generic" drug makers use different fillers for their medications. The dosage of the "medication" must be within strict limits just like the Brand names. For some people the fillers can cause the medication to work differently. Just like all medications don't work for all people, generics may not work for some people.. Bottom line 1) the drug companies do wine and dine physicians to get them to write "only" the Brand Name. 2) Generics are the same medication as the Brand Names and 3) you can't know if a generic is going to work unless you try it......RW


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## Inthegarge (Feb 5, 2010)

Doc_5729 said:


> My wife takes two prescriptions just to survive. These meds are rather expensive and even with insurance the Co-pays are ridiculous.
> 
> When we asked about "generic's" to lower our out of pocket expense, the answer was NO!!!!
> 
> ...



So can the Brand name medications.......RW


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## Doc_5729 (Feb 5, 2010)

Inthegarge said:


> So can the Brand name medications.......RW



The Dr/Surgeon that told us that is capable of ripping your chest open and repairing such items as heart valves on a beating heart and waking you back up after 8.5 hours of surgery.

Now I'm not dumb by any means, but I don't quiet have the credentials, and I don't think anyone on this Message board does, to question his reasoning or authority on the subject.

I just pay the bills without regard to cost because having my wife alive and in good spirits is better than the consequences and delays them for hopefully a long time.

To each his own.

Good Luck and Best Wishes for you and your wife. and please pardon my interruption.


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## Bow Only (Feb 6, 2010)

Inthegarge said:


> Let's see the FDA approves Brand Name medications and "generic" medications. So they are allowing companies to sell medications that are not really the medications ??? The reality is the "generic" drug makers use different fillers for their medications. The dosage of the "medication" must be within strict limits just like the Brand names. For some people the fillers can cause the medication to work differently. Just like all medications don't work for all people, generics may not work for some people.. Bottom line 1) the drug companies do wine and dine physicians to get them to write "only" the Brand Name. 2) Generics are the same medication as the Brand Names and 3) you can't know if a generic is going to work unless you try it......RW


Thank you.


Doc_5729 said:


> The Dr/Surgeon that told us that is capable of ripping your chest open and repairing such items as heart valves on a beating heart and waking you back up after 8.5 hours of surgery.
> 
> Now I'm not dumb by any means, but I don't quiet have the credentials, and I don't think anyone on this Message board does, to question his reasoning or authority on the subject.
> 
> ...



Actually, surgeons know less about medications that your regular physician.  They specialize in a craft that doesn't involve many medications.  
As for credentials, I beg to differ.  What medications is your wife taking?  If you don't feel comfortable posting them, PM me.


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## Mattval (Feb 6, 2010)

I dont know about the topomax but I have been taking the generic imetrix injection for about 3 years for my clusters.  to me it works as good as the imetrex.  My pharmacy will give mme generics if the the real stuff is to expensive.


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## Bow Only (Feb 6, 2010)

Imitrex 6mg inj. - acquistion cost ~$450
Sumatriptan 6mg inj - acquistion cost ~$57

Cash price mark up would be anywhere from 10 to 20% on brand, 100 to 200% for generic.


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## whateverjones (Feb 6, 2010)

My buddy used to have unbearable cluster headaches ,after he got a CPAP to help him breath at night,I think his headaches are near nonexistent.It took about 2 weeks but they finally stopped. Maybe you have already tried this,but if not it is worth a try.


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## Doc_5729 (Feb 6, 2010)

Bow Only said:


> Thank you.
> 
> 
> Actually, surgeons know less about medications that your regular physician.  They specialize in a craft that doesn't involve many medications.
> As for credentials, I beg to differ.  What medications is your wife taking?  If you don't feel comfortable posting them, PM me.



Actually I should correct that "Dr/Surgeon" and put "Cardiologist"/Surgeon in it's place.

I don't care to discuss it any further, my wife is alive because of him and remains alive because of him and I'm not whining about the cost of her medications.

As I said, Good Luck and pardon the interruption.


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## mattech (Feb 6, 2010)

Twenty five ought six said:


> To answer the OP's question, Dr's get gifts and "honorariums" for prescribing name brand drugs.



technically. not anymore. There have been quite a few laws put ito place for this type of thing. I work in the medical field as a vendor, we used to take our customers out to lunch bring in breakfast and give them all kinds of gifts, that is a BIG no no now, even the pens we used to give out with our name on it are just regular pens now. that being said there are people who do not follow rules and find loop holes in the system. have you noticed you dont see to many pens nowdays with presciption names on it. and the ones you do see have just been lingering for a while. 

I would also suggest a second opinion dr to get generic rx wrote.


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## DYI hunting (Feb 9, 2010)

Bow Only said:


> I'll check on the injectable price to see what kind of deal you might be able to get.  I guess she has tried Indomethacin?
> Difficult to treat CPH.



Her doctor only want to use Indomethacin as a last resort and said we are not to that point yet.  We have tried about everything else.  He wants to go through several meds she has tried in the past but at much higher dosages and see if they have any effect.  He believes since her family is all short and she is only 4'10", it is likely a genetic Pituitary defect causing much of her problems.  Both my daughters have headaches, but nothing near as severe or as often...yet.

It kills me, she has a constant dull headache and on bad days has a severe headache "suicide headache" as they call it that varies in intensity from really bad to excruciating "100 more painful than having a baby" is the description.  At those points, the only hope is going to the ER and getting an injection that knocks her out for a day.


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## Bow Only (Feb 10, 2010)

DYI hunting said:


> Her doctor only want to use Indomethacin as a last resort and said we are not to that point yet.  We have tried about everything else.  He wants to go through several meds she has tried in the past but at much higher dosages and see if they have any effect.  He believes since her family is all short and she is only 4'10", it is likely a genetic Pituitary defect causing much of her problems.  Both my daughters have headaches, but nothing near as severe or as often...yet.
> 
> It kills me, she has a constant dull headache and on bad days has a severe headache "suicide headache" as they call it that varies in intensity from really bad to excruciating "100 more painful than having a baby" is the description.  At those points, the only hope is going to the ER and getting an injection that knocks her out for a day.



Man, that is rough.  I feel for her and your family.  In my personal opinion, it is better to try other medications like Indomethacin than to try Imitrex or other meds in high doses.  Imitrex in high doses is not heart friendly.

Has she tried a Ketogenic diet?  That's hardcore and difficult to do, but at this point, anything is worth trying.  Heck, a high sodium diet could be triggering her attacks.  I would modulate her diet and keep a log as to when she as an attack and correlate it to what she ate the day before.  If you do this, the macronutrient breakdown is critical.


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## 7mm REM MAG (Feb 10, 2010)

> Even after pleading with them about the cost, the doctor refused to prescribe generics? This is ridiculous, the generics are less than half the cost of the name-brand.



Perhaps the Doctor is doing what is right for the patient.  He is treating her like he would treat himself or his wife and giving her the best treatment.



> Our insurance doesn't cover prescriptions



Here is part of the problem.  Your insurance company is making a profit too.  Who do you think make more money:  insurance companies or physicians?

Thirdly, you should take responsibility for yourself.  Or would you rather have a government funded health care plan?


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## 7mm REM MAG (Feb 10, 2010)

Don't forget the pharmaceutical companies.  They turn quite a profit also.


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## Randy (Feb 10, 2010)

My doctor also said no generics.  And when I questioned him about handleing my cholesteroal via diet and exercise he was quick to say he was no dietition and he would NEVER take me off these drugs.  There has to be something to the "kick backs" or these doctors would not be so dead set against generics or diet to get you off them.  I have to take the Plavix for a year anyway based on my research so I will give him a year.  If he does not come around I will have to find another doctor.  I can not afford this 400 per month.


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## 7mm REM MAG (Feb 10, 2010)

Don't forget that patients will sue a Doctor at the drop of a hat.  If the Doctor does not go by the book, they get sued, even if the patient is the one at fault.


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## 7mm REM MAG (Feb 10, 2010)

If a patient knew how to treat themself, then why are they going to the doctor in the first place?  The Doctor (in most cases) knows what they are doing.  If you don't want the doctors advice, then don't go to the doctor.


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## FishingAddict (Feb 10, 2010)

Generic meds many times do not work as well as the branded (non generic) medicines.

For example, a branded drug has to be with in 99% of the dosage labled.

A generic drug can be from 85-120% of what is labeled.

Also, a branded drug has gone thru many tests to make sure that it has good "bioavailbilty"...in other words, there has been many tests done on it to make sure that you know exactly how much your body is absorbing.

That is not the case with generics.  In fact, tecnically you could coat a generic drug in concrete and sell it- even thought the body is not absorbing it.

I have heard many reports of people who have been on branded topamax and had good migrane control, but when they switched to generic, they started getting migranes again.

That being said, it's worth a try to start on generic first to see if it works- it's not a life saving drug, so to speak (which, if does not work, you die)- you know the results immedatly.

Imitrex is either not yet generic, or just went generic, which means that you won't find much cost savings with the generic at this point.


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## FishingAddict (Feb 10, 2010)

By the way, just so people know-

Reps are not allowed to wine and dine doctors any more. They used to.


It went from paying for doctors to play golf, then that got yanked, then they could take the doctor and wife to a fancy dinner, then that got yanked...

So on and so forth- until now reps can't even give doctors free pens anymore.


Pharma reps have VERY little influance on doctors anymore.  Way too many rules, way too many reps.


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## dawg2 (Feb 10, 2010)

Bow Only said:


> The 20% variance that was quoted was incorrect.  As for Prilosec, I don't know of a pharmacy that carries the brand.



Better do some research.  Generics are not the same.


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## Inthegarge (Feb 10, 2010)

According to the FDA......

Generic drugs are important options that allow greater access to health care for all Americans.  They are copies of brand-name drugs and are the same as those brand name drugs in dosage form, safety, strength, route of administration, quality, performance characteristics and intended use. 

Health care professionals and consumers can be assured that FDA approved generic drug products have met the same rigid standards as the innovator drug. All generic drugs approved by FDA have the same high quality, strength, purity and stability as brand-name drugs.  And, the generic manufacturing, packaging, and testing sites must pass the same quality standards as those of brand name drugs.
For more information, see Facts and Myths about Generic Drugs.

http://www.fda.gov/Drugs/ResourcesF...afely/UnderstandingGenericDrugs/ucm167991.htm

Read my original post as this is what I said previously. Get your information from the horses mouth and not the other end.........RW


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## FishingAddict (Feb 10, 2010)

Inthegarge said:


> According to the FDA......
> 
> Generic drugs are important options that allow greater access to health care for all Americans.  They are copies of brand-name drugs and are the same as those brand name drugs in dosage form, safety, strength, route of administration, quality, performance characteristics and intended use.
> 
> ...



I can promise you they are checked very carefully for quality assurance, but I can also promise you that they have a 20% leeway on dosage and have never been checked by the FDA for bioavalibilty.


I used to sell pharma drugs, and we had litature encouraging doctors to write branded only because of those issues.  This litature was approved by the FDA, and they are incredibly strict in approving sales aids.

Again, I would try to give the generic topomax a try to see if it works, and if it does not, go for the more expensive one and see it works better.

On that note, never ever go with generic coumidin (blood thinner) because the dosage/efficacy can change for each manufature. Most cardiologists know that and will write brand nessicary, but there are some who do not.


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## FishingAddict (Feb 10, 2010)

Randy said:


> My doctor also said no generics.  And when I questioned him about handleing my cholesteroal via diet and exercise he was quick to say he was no dietition and he would NEVER take me off these drugs.  There has to be something to the "kick backs" or these doctors would not be so dead set against generics or diet to get you off them.  I have to take the Plavix for a year anyway based on my research so I will give him a year.  If he does not come around I will have to find another doctor.  I can not afford this 400 per month.




If I'm not mistaken, you had a stent put in after your heart attack?

The stents they put in now many times have a drug coated on the outside of them that prevents them from clotting off your artery after it's put in.

Problem is, it's been found that since the drug coated stents don't allow the body to react with them, your body never allows it become part of the vessle, so to speak- it never bonds 100% with the vessle wall. 

Which leads to another risk 3-5 years (or more) down the road...instead of throwing a clot in the vessle right after the sugery, which was quite common with old verson stents, there is now a risk of throwing a massive clot several years down the road. The risk is MUCH less than the "old" days, but it can happen, which is why your cardiologist says "forever" on the plavix...

Since this was found out, about 25% of the doctors will not put drug coated stents in anymore because of the risk (plus drug coated stents cost $5k vs $500)...used to be that everyone got drug coated stents, now it's about 1/3 of that (at least a couple years ago in the hospitals I called on)

I imagine he wants no generics because again, there are 1000's of cases where generic did not do the same thing as the branded thing.

But again, I'll always get generic first if it's not a life threatining thing.   If it does not work, I 'll upgrade.


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## dawg2 (Feb 10, 2010)

Inthegarge said:


> According to the FDA......
> 
> Generic drugs are important options that allow greater access to health care for all Americans.  They are copies of brand-name drugs and are the same as those brand name drugs in dosage form, safety, strength, route of administration, quality, performance characteristics and intended use.
> 
> ...



My info comes from the DOCTORS and PHARMACEUTICAL REPS.  Just an FYI.  

I know a Doctor who has had patients not respond as well with generics and prescribe only the name brands because of problems with them.  They do vary and according to him, he even said up to 20%.  This Doctor I am referring  is extremely smart and spends his spare time after work, working and researching both medications and treatments for his patients.  He is also a specialist and not a family practice doctor.  I am sticking by his research since he has a horse in the race and deals with this everyday.

Personally, if the generics worked, then fine, save the money.  If not, then use name brand.  But if a doctor told me a specific generic was not getting good results for prior patients, I would go with his opinion.


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## dawg2 (Feb 10, 2010)

FishingAddict said:


> I can promise you they are checked very carefully for quality assurance, but I can also promise you that they have a 20% leeway on dosage and have never been checked by the FDA for bioavalibilty.
> 
> 
> I used to sell pharma drugs, and we had litature encouraging doctors to write branded only because of those issues.  This litature was approved by the FDA, and they are incredibly strict in approving sales aids.
> ...



What he said.


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## Bow Only (Feb 10, 2010)

There are so many inaccurate statements that I can't even quote them all.  

Guys, I've been a registered pharmacist for 17 years.  I know a little about what I'm talking about.  

Generics must be AB rated to legally dispense instead of the brand.  It's actually a law in GA that the pharmacist must dispense the least expensive AB rated medication unless otherwise directed by the physician. 

And generics don't have bioequivalance studies, really?


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## FishingAddict (Feb 10, 2010)

Bow Only said:


> There are so many inaccurate statements that I can't even quote them all.
> 
> Guys, I've been a registered pharmacist for 17 years.  I know a little about what I'm talking about.
> 
> ...



Straight from the FDA's mumbo Jumbo page:

Sec. 320.22 Criteria for waiver of evidence of in vivo bioavailability or bioequivalence.  
(a) Any person submitting a full or abbreviated new drug application, or a supplemental application proposing any of the changes set forth in 320.21(c), may request FDA to waive the requirement for the submission of evidence measuring the in vivo bioavailability or demonstrating the in vivo bioequivalence of the drug product that is the subject of the application


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## Bow Only (Feb 11, 2010)

FishingAddict said:


> Straight from the FDA's mumbo Jumbo page:
> 
> Sec. 320.22 Criteria for waiver of evidence of in vivo bioavailability or bioequivalence.
> (a) Any person submitting a full or abbreviated new drug application, or a supplemental application proposing any of the changes set forth in 320.21(c), may request FDA to waive the requirement for the submission of evidence measuring the in vivo bioavailability or demonstrating the in vivo bioequivalence of the drug product that is the subject of the application



Do you know the difference between in vivo and in vitro?


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## dawg2 (Feb 11, 2010)

FishingAddict said:


> Straight from the FDA's mumbo Jumbo page:
> 
> Sec. 320.22 Criteria for waiver of evidence of in vivo bioavailability or bioequivalence.
> (a) Any person submitting a full or abbreviated new drug application, or a supplemental application proposing any of the changes set forth in 320.21(c), may request FDA to waive the requirement for the submission of evidence measuring the in vivo bioavailability or demonstrating the in vivo bioequivalence of the drug product that is the subject of the application





Bow Only said:


> Do you know the difference between in vivo and in vitro?



Not sure if FA does (I bet he does), but it means "in body" as opposed to "outside the body" (in vitro).

So unless I am reading the quote by FA incorrectly, it looks like they can waive the "in body" bioavailability / bioequivalence of a generic drug....


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## FishingAddict (Feb 11, 2010)

dawg2 said:


> Not sure if FA does (I bet he does), but it means "in body" as opposed to "outside the body" (in vitro).
> 
> So unless I am reading the quote by FA incorrectly, it looks like they can waive the "in body" bioavailability / bioequivalence of a generic drug....



Exactly, Dawg2.

And since we are test tubes....


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## Bow Only (Feb 11, 2010)

This isn't going to be a pharmacokinetics lesson, but this helps explain the differences.  AB rated medications are therapeutic equivalents.  

http://www.scientificamerican.com/article.cfm?id=whats-the-difference-betw-2004-12-13


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## Big7 (Feb 11, 2010)

*Stadol (Brand Name) spray...*



Davans said:


> I'd find me a new Doctor.



ME TOO!

Plus ask about Stadol (Brand Name) but available as a generic now.. 
(butorphanol tartrate)
LOOK HERE: http://www.rxlist.com/stadol-drug.htm

Used to be that you couldn't get it b/c of patent
issues..??

It is not cheap... about $75.00 if you pay cash
but most insurance co-pays are $5.00 - $10.00
About 20 "doses"

This IS NOT just "nose spray" it is a schedule IV (4)
narcotic and you MUST not take more than what
they tell you.

Your wife will develop a tolerance so she will have 
to use it on and off for it to be effective.

Should be able to use it for about 6 months b/f it
starts to lose it's effectiveness..

Been there and done that..
This stuff works great!
Some docs won't write it though b/c some people
 just use it like afrin and it is dangerous when you take to much of it.

I've been fighting these headaches for years..
Even had sinus surgery back in 2002...

They wanted to try me on topamax and some other "new"
stuff but WAAYYY to much $$$ for me.

Worse side effect= you will get sleepy until you get
 used to it and it makes your eyes look like you been smoking weed.
(small pupils) so get ready for some funny looks from folks.

I feel sorry for people with these headaches. They are bad and REALLY hurt.


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## FishingAddict (Feb 11, 2010)

Bow Only said:


> This isn't going to be a pharmacokinetics lesson, but this helps explain the differences.  AB rated medications are therapeutic equivalents.
> 
> http://www.scientificamerican.com/article.cfm?id=whats-the-difference-betw-2004-12-13



From the article...

_Additionally, the generic needs to meet pharmacokinetic parameters in the body, which means it must dissolve (in a beaker) at the same rate and to the same extent as the original. This process ensures that the two products are bioequivalent because if product A and product B dissolve in a virtually identical manner, then they *should* behave the same in the body.
_


Note the word "Should."  But time and time again, my wife and many other doctors have seen that it's not the case many times.

Case in point:

What percentage of generic coumidin do you fill?

What percentage of generic lisinopril do you fill?

Which one is more important to get exactly right?

Just food for thought!


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## FishingAddict (Feb 11, 2010)

BTW, sorry to sound like such a know at all....I don't mean to come off that way.  Believe it or not!!


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## Bow Only (Feb 11, 2010)

FishingAddict said:


> Case in point:
> 
> What percentage of generic coumidin do you fill?


100% generic dispensed for me, the wife says she dispenses less than 2% brand and that is mostly from the old physicians that didn't see the data on the newer formulations of warfarin.  


FishingAddict said:


> What percentage of generic lisinopril do you fill?


100% generic


FishingAddict said:


> Which one is more important to get exactly right?


If you are talking accuracy, both are equally important.  If you are talking which one has more potential for drug interactions and problems, Warfarin is more critical.  

I don't know if you were trained in the 1980's, but Warfarin has come a long way since the early formulations that were not bioequivalent.  Digoxin, carbamazepine, and levothyroxine have all changed since those days and are AB rated bioequivalents with the brand.  Of those, levothyroxine is the one that some people respond differently than with the brand.  Some do better on the generic than with the brand and some generics actually have a better pharmacokinetic profile than the brand.  

You have a differing view than I do, that is fine.  It's just my job every day to be right about medications and their effectiveness.  If I didn't think they were "equal" to the brand medications, I wouldn't dispense them.  And to be honest, I don't know a pharmacist that thinks like you do.


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## DYI hunting (Feb 11, 2010)

I just wonder how much this affects dispensing name-brands?



> Nearly 20 percent of American doctors get paid by drug companies to be consultants or speakers, and in some cases, they're making quite a lot of money.


http://www.myfoxatlanta.com/dpp/news/fox-5-special:-dollars-for-docs-021010

We are going to try the generics first then go to the name brands if they don't work.  It seems the logical route, start cheap and then go up from there if they don't work.  




7mm REM MAG said:


> Thirdly, you should take responsibility for yourself.  Or would you rather have a government funded health care plan?



What is that supposed to mean?  How is asking for generics because we have no Rx plan in our medical insurance?  The fact I have insurance and pay my medical bills should be enough to show I am taking responsibility for ourselves.


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## Bow Only (Feb 11, 2010)

DYI hunting said:


> I just wonder how much this affects dispensing name-brands?
> http://www.myfoxatlanta.com/dpp/news/fox-5-special:-dollars-for-docs-021010


I've seen cases where I thought the doctor was biased and not in the best interest of the patient.  It's not as common as you would think but I'd still say it was 10%.  



DYI hunting said:


> We are going to try the generics first then go to the name brands if they don't work.  It seems the logical route, start cheap and then go up from there if they don't work.



That is a smart way to approach it IMO.


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## fishinknots (Feb 12, 2010)

Do doctors get gifts or kick-backs from the drug companies for prescribing specific brand meds?

YES!


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## FishingAddict (Feb 13, 2010)

fishinknots said:


> Do doctors get gifts or kick-backs from the drug companies for prescribing specific brand meds?
> 
> YES!



No, they don't.  They used to get taken to dinner and golf to encourage it, but that's been banned. 

Pharma reps can't even leave them pens anymore!


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## sleepindawg (Feb 13, 2010)

Generic BP medication wouldn't work for me...found out it was manufactured in India.  I think we even import drugs from China, and they can't even sell us a safe dog food!  Sorry, but I don't have that much faith in the FDA.  It's just a pawn of the pharmaceutical conglomerates...or is it the insurance companies?


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## Bow Only (Feb 15, 2010)

sleepindawg said:


> Generic BP medication wouldn't work for me...found out it was manufactured in India.  I think we even import drugs from China, and they can't even sell us a safe dog food!  Sorry, but I don't have that much faith in the FDA.  It's just a pawn of the pharmaceutical conglomerates...or is it the insurance companies?



There is a reason Walmart can sell meds below my cost.


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## sleepindawg (Feb 15, 2010)

yep...the same reason that the New Jersey maker of my original BP medication (which worked fine for 10+ years by the way) quit manufacturing it altogether. The insurance now pays for two generic meds because it refused to pay for one name brand prescription.


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## alphachief (Feb 15, 2010)

Indeed...the days of the "unrestricted educational grant" are long, long gone.


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