woman holding water and pills in her hand

Here’s a topic that I have to deal with on a daily basis in my practice – and it can be frustrating for both me and my patients. Here’s what happens. I prescribe medication A for my patient. She gets the prescription filled and receives medication J. Medications A and J contain the same amount of the same “active ingredients,” but the name has been changed. The patient is concerned and confused and calls my office wondering if they have the wrong medication, if I made a mistake, if the pharmacist made a mistake and why this happens.

First of all, there’s no mistake, and what happens is that name brand medications are often substituted with a lower cost generic medication that is equivalent to the brand name medication.  

And, sometimes, for instance in January or when your open enrollment for your health insurance comes ups, the insurance companies will often update and change the medications and drugs they cover. This is known as a Formulary change, and often causes further confusion. 

Wait, what? A person can be doing really well on brand-name Medication A, and then be changed to Medication J, but 6-12 months later, they may be picking up a different generic substitute for the original name-brand A–and now be on Medication R.  

Just this week, I was I my pharmacy picking up my medications and witnessed a person yelling at the pharmacist because the medication he had been on for years, was substituted. 

Why is Your Prescription Substituted with a Generic?  

The short answer is, wait for it… cost. Yes, you guessed it.

Pharmaceutical companies spend time and money developing new drugs and then wait for the Federal Drug Administration (FDA) to approve them. They then receive a patent on that drug, which means they have exclusive rights to sell it and make a profit. This patent protection lasts about 20 years. 

When the patent on that drug has expired another company can make a generic version. The FDA states, “Any generic medicine must perform the same in the body as the brand-name medicine. It must be the same as a brand-name medicine in dosage, form and route of administration, safety, effectiveness, strength, and labeling (with certain limited exceptions). It must also meet the same high standards of quality and manufacturing as the brand-name product, taken and used in the same way as well. This standard applies to all generic medicines.”

Generics are cheaper because the companies that make them do not have to do the research & development to create the drug and FDA approval times are much faster the second time around. They also don’t spend billions on advertising as is the case with brand-name drugs. Patients and hospitals save many millions of dollars yearly using generics. Chances are the prescription you have now is not a brand name, as almost 80% of prescription drugs sold are generics. 

Insurance Companies and Generics

Another complication that happens with prescriptions also involves the insurance companies. For example, I may prescribe the Yaz birth control pill for a patient. Yaz has six or seven different generics, but the patient’s insurance company only covers one of the generics–but which one? 

I do not have access to that information ahead of time, and what they covered in 2019, is not what they are covering in 2020 or 2021! You can see how this causes delays and frustration all around. Be forewarned, when you get to the pharmacy, what you receive may not be the same name as what your practitioner has prescribed. Your pharmacy may switch to a generic because of your insurance coverage.

So, What Are the Differences with Generics?

While the active ingredients are the same in a generic pill as a brand-name one, the other ingredients in the pill, such as fillers, coatings, flavorings, or preservatives, can be different. These can affect how quickly, or slowly, the medication gets absorbed into your system.

Possible Concerns

These variations are usually slight and have no ill effect. But there are some conditions, such as seizure disorders, where lack of absorption could be a serious problem. If you are not getting the level of the drug in your blood that you need, you could have a seizure.

Drugs called NTIs for narrow therapeutic index are drugs that have a narrow margin between the amount that is effective and safe and the amount that is toxic. The list of restricted NTI drugs varies from state to state, and the FDA does not have a list of recognized NTI drugs.

These generic drugs include:

  • warfarin (a blood thinner)
  • digoxin (treats certain heart conditions)
  • theophylline (treats asthma, COPD, and other lung diseases)

Discuss your health conditions and medications with your health care provider to make sure you are getting the best choice for your situation.

There are also patients who definitely feel certain generics are easier on their stomachs, or work better for them in other ways. If you find a generic that works for you, ask your pharmacist who manufactures it. You can request that version when you get a refill and check about your insurance. 

Medication Safety Tips

As always, you are your own best advocate for your health and when it comes to prescription medications, you may have to do more of your own research.

  • Always thoroughly read the label on your medication and the accompanying leaflet before taking your medicine. Check the label and dosage, even if you have been taking this med for years.
  • Best on an empty stomach? Or with food and liquids? This information will be clearly stated on the bottle label. 
  • Some liquid medicines must be stored in the fridge, check the label.  
  • If you have questions, do ask your pharmacist. They are knowledgeable and working with you is part of their job.
  • If you do better on the name-brand, your provider will need to indicate that on the prescription. There are many designations we use to instruct pharmacists not to substitute, and these vary by state.

How to Find Out What Medications are Covered

The very best way to do this is to call your insurance company and ask specific questions. You might also go to their website and search for their Formulary. This will give you an idea of what’s covered for any medication you take regularly.

If calling is easier, here’s what to ask:

• What are the names of the medications/generics for my brand-name medication that are covered by my plan?  

• What costs should I expect to pay if I wanted the brand-name?  

• What is the cost for the generic substitutes? 

I hope this helps clear up some of the confusion.

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