Erickson Tribune

Health Secrets

UPDATED: Tuesday, January 17, 2006

It’s Generic! No, It’s OTC! No…What IS It?!

Posted on Friday, July 01, 2005
 

By Wendy J. Meyeroff
THE ERICKSON TRIBUNE

There can be wallet friendly options for people reeling at the ever-increasing costs of brand name prescription drugs. The trick is knowing what you can substitute and when. It’s not easy.

Using Generics

In the United States, when a manufacturer develops a drug, it receives a patent for a certain number of years. Once the patent expires, other companies can manufacture a generic version. The generic —e.g., metformin instead of Glucophage for diabetes—must have the identical active ingredients as its brand-name counterpart.

Kathy Justice, R.Ph., who manages the pharmacy at Charlestown, an Erickson built and managed community in Catonsville, Md., offers this warning regarding generics: “Someone may be used to an oval, red capsule and the generic is a round, white tablet. I have to make sure they know the difference.”

If several generics are all round and white, Justice works to help people distinguish between them, like putting each in a separate compartment of a seven-day pill holder.

‘Essentially the Same’ Drugs

Over-the-counter (OTC) drugs also have generic versions (e.g., Advil and ibuprofen) but don’t assume the OTC (or its generic) can be exchanged with a brand-name prescription. HMOs are encouraging prescription-to-OTC exchanges with this potentially dangerous phrase,“essentially the same.”

Consider Prilosec and Nexium. Prilosec was the original prescription and now has an OTC variation, and it may be feasible to switch from the prescription to OTC. If your HMO tells you, “We’re not covering Nexium anymore; go buy Prilosec at the drugstore. It’s essentially the same,” you’re being misled, says Matt Narrett, M.D., medical director at Charlestown.


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Both drugs are proton pump inhibitors (PPIs) designed to fight chronic heartburn. Both are made by AstraZeneca. Both come in almost identical “little purple pills.” But Narrett emphasizes, “They may be the same class of drug by the same manufacturer, but that doesn’t mean there are no differences. They are a bit different, just as Macintosh and Winesap are two different types of apples.”

That means switching between two different drugs—even if they’re in the same category—should only be done after careful discussion between doctor and patient and with the doctor’s monitoring. About the Money Question

Narrett says OTC Prilosec costs about 60 cents a pill instead of $2 to $3 for the prescription version. So if you can make the switch, you can indeed save money. But what if you’re getting the Prilosec-for-Nexium solution from your HMO? Then it gets a little trickier.

An OTC drug may or may not be as potent as the slightly different prescription medicine. What if you need two tablets of Prilosec a day to provide the relief of one Nexium?

If Justice didn’t tell you that 10 mg of OTC Claritin was equal to 5 mg of prescription Clarinex (again, slightly different drugs), would you know? Probably not...which is another reason it’s critical for you to have some discussions with your doctor or pharmacist before making substitutions.

Don’t assume the OTC medicine is always cheaper. A 28-pack of Prilosec can run about $20 retail. Depending on the type of insurance you have for medications, that may or may not be cheaper than a prescription acid fighter.

Also notice the pill count. If you’re looking to get a one-month supply and to you that means 30 pills, this won’t satisfy you; there are only 28 pills in the package. Some OTC drugs come with less in a package, some with more. So factor that into your costs.

Don’t Make Assumptions

Many customers demand generic medications, but there isn’t always one available and if there is, your doctor’s and insurer’s instructions come into play.

“If the doctor has not checked Dispense as Written on your prescription, the pharmacy is free to provide you with a generic,” says Justice. “Sometimes the HMO requires the pharmacy to use it. When doctors have specifically requested the brand name, we have to alert them to the HMO’s rule. Many times physicians agree to the generic, but if the patient must take the brand name, the doctor has to fight the insurer.”

Obviously the desire to save money when it comes to purchasing medication can lead to confusion and even danger. The best advice remains: do not make assumptions and talk carefully with your health professionals.



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