- Health Care, Drugs & Insurance
Generic vs Brand Name: What's Good For One May Not Be Good For Another
Generic vs. Brand Name Drugs
I prefer generic over brand name drugs because of the low cost and mostly the same results. However, I must also say there are times when generics just don’t work well for me and others. I believe this depends on the individual's genetics. After speaking with others and my endocrinologist, many factors come into play.
Levothyroxin vs. Synthroid
Patient's Point of View
1. Premarin: I myself, get a better result with this name brand. This has been proven to be true for at least 19 years of my personal experiences after trying other supplementary medications in hopes to save money. I have had to go back to Premarin.
2. Levothyroxin vs. Synthroid: I have a couple of family members that have found their levels fluctuate when using levothyroxin. This medication is used to replace a deficiency in the thyroid hormone. A person's thyroid gland controls the metabolism. Just recently, after speaking with another family member, I discovered that this sibling also has to take Synthroid, due fluctuating levels on the generic medication.
Thyroid Replacement Choice of Treatment
Do you suffer from a Thyroid disorder?
My specialist explained to me that in this case, just because the levothyroxine has the same
ingredient and the same dose, doesn’t mean that the generic drug will have the exact dose each and every time. This depends on the manufacturer.
For example, if the levothyroxin is slightly off from a dose of 0.075 mg this is acceptable by the FDA table as 75mcg (0.075 mg). So depending on which manufacturer a patient receives their medication from, one month it could be a true 75 mcg and the following month could be higher or lower.
When a patient has their blood work done, their results might be found to be normal. However, the months before, because of manufacturing variability their dosing is often variable enough to produce symptoms such as mood changes, fatigue and other symptoms of insufficiency. This may not have the same outcome with every patient. These are approved as legal substitutions for the brand name drug, Synthroid. and as so often happens insurance companies refuse to cover the cost of superior brand name drugs.
FDA & Thyroid Medication
The percentage the FDA has set for Levothroxine.
Comparison Making a Drug Like Making a Cake
A friend once said, that after he was having problems with the generic drug to treat his thyroid issues, his specialist explained to him that making a drug is like making a cake. The manufacturer may have all the same ingredients, same amounts and mixes them in the same order but there's no guarantee that another manufacturer with the drug will take those exact same steps.”
It's why cakes taste different depending on who's making it and why the same generic drug may be different from month to month.
My Personal Experience with a Pharmacist's Point of View
After standing in a long pharmacy line in a big city away from my home state, I arrived
back at the place I had taken up residency for a few days. I reached into my bag to discover my label on my medication bottle said, levothyroxin. Disappointed in myself for not noticing this before I left the counter; I called the pharmacy and spoke with the woman that filled my prescription.
She said something like, “Ma’am, these have the same ingredients, they are the same dose and we show that your doctor will approve you for generic.”
I said, “The whole reason for my office visit with this doctor was discussing the generic that I have been already taking and how my family has told me I was showing some of the same signs as they were when they were taking levothyroxin.”
“Well then, why doesn’t your doctor just up your dose?”
“Maybe, because the higher dose would be too strong," I responded. "I'm not a doctor how would I know? My doctor explained to me what can happen with this particular generic drug.”
Her tone became more aggravated, “It’s the same ingredient and same strength.”
At this time I’m thinking, she may know her drugs but she’s not my doctor, “Why would he give me samples of Synthroid if he was going to fill-out a prescription for levothyroxin?”
She softened her tone but still sounded as though I offended her, “Ok, since your whole visit was about changing your prescription, bring the medication back in and I’ll exchange it.”
I said, "Thank you." I hung up the phone and rushed back to the pharmacy before they closed. I was thankful for her breaking the rules because as far as I know, this seldom happens.
Not All Drugs Have A Generic Choice
No one knows a person better than themselves. The insurance companies are not doctors, pharmaceutical companies are not physicians, politicians aren't physicians. If by chance anyone working those positions also carry a physician's license, what qualifies them to make health decisions toward patients they haven't seen face to face or without knowing their past history? Even nurses playing an important role by listening to patients and being their advocate aren't doctors. Insurance companies, pharmaceutical companies, politicians, physicians, and nurses all have something in common. They have the ability to listen to all the people fighting these health issues, they can be patient advocates working together with the doctors and their patients. Please keep in mind, what works for one may not work for another.
Interview with a Family Doctor
I had discussion with a family physician that went something like this:
He said “levothyroxine is one of the generic drugs that the FDA has approved to be within a 20% variance (10% on each side) of the dose printed on the label of the bottle. This means some months a person could be at the low end, at a high end or bounce between the levels. Over all, depending on the persons sensitivity, it may not be noticeable, but often it allows symptoms of too little or too much thyroid hormone to be noticeable. With the brand name, Synthroid, you know the level is the exact level written on the bottle.”
I said, “My endocrinologist that I had to see in North Carolina was explaining to me about the 20% range. He’s among at least three endocrinologists in Virginia and at least one in Iowa treating their patients with the brand name, Synthroid because they had a hard time controlling their patient's thyroid symptoms with the generic drug.”
He responded, “This is a mood-affecting drug. Some drugs are fine as generic because some disorders don't matter if a patient's level is within a 20% range. However, diseases like hypothyroidism, seizures or heart arrhythmias, we want to be sure they are on the exact dose. Allowing a 20% variance in drug levels can lead to serious and life threatening side effects. Being low or high by 20% over a period of six months could cause a person to have a seizure or someone suffering with heart arrhythmia could die. Unfortunately, doctors no longer have control. They can appeal to insurance companies to get them to pay for the medications but often fail.”
"That has happened to me," I said. " I once had a doctor appeal to my insurance company explaining why I required Nuvigil. The insurance company turned him down. I personally had to write my insurance company and told them they would be responsible to take care of my family if I died because I couldn't have this drug. Reluctantly, they approved this drug but unfortunately due to a job change and health insurance change, I'm back to square one again.
“You can help others by educating them like you are doing here. You can tell them they have a right to appeal to their insurance companies who are trying to substitute a less expensive and less effective medication. If more people did this, insurance companies might begin to remember who the actual customer is and who's helping keep them in business," he said.
A Few Generic & Brand Name Medications
None but there are different kinds of estrogen replacements.
None but insurance companies will try to force patients to try other medications first.
I have recently discovered that sometimes when a person is denied a prescription this may not be because the patient is ineligible. This could mean that a provider’s number failed to be reported or for a simple reason as to not enough documentation supporting the reason for why the particular medication was denied. Therefore if you are denied, I say to you, call your insurance company and ask why? What can it hurt, besides being on hold for a few hours or maybe even half of the day? I have been asked over and over if this was due to the “Obama Care” and I can honestly say, no. These problems existed before our president was voted in office the first time.