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Brand name vs. generic drugs
| December 4, 2009 | |
| Dr. Gary Huber : Head Medical Ego |
One of our astute HAE readers recently asked my opinion about brand named vs. generic drugs after a story he had seen in the news. It’s come up before, so I wanted to discuss it with everyone.
Theoretically there shouldn’t be a great difference in brand name vs. generic but in actual practice this can present a problem for many patients. When a generic is made the active chemical or drug compound is the same but how it is bound in a tablet or how it is released from the formulation can make a significant difference in how well it works. It is this difference that accounts for frequent differences in how the generic works compared to the brand name. Not all generics are inferior but how any one individual may react to them is hard to predict in my experience.
In some cases, the generic is just as effective as the original but at a fraction of the price. One good example of this is Flomax. We have all seen the ads on our TV, of the guy who is missing the game or who can’t drive his ball off the tee because he is running to the bathroom all the time. Then we see shots of him and his smiling friends as they happily play together with confidence as there bladder control issues have been magically eliminated with the help of Flomax. Hell, it makes me want to run out and get some Flomax so I can fit into that “fun” picture they present. But there is a reason those ads look so fun. The manufacturer, Boehringer Ingelheim, spent $116 million in advertising to make it look great. You get to share in that expense when you purchase your Flomax for $246 for a one month supply. Now who’s smiling? Studies have shown that the generic, doxazosin, which costs less than $10 works just as well for most men. So in this case, the generics save you and your insurance carrier a lot of money.
Well now that brings the other billion dollar baby into the picture . . . the insurance companies. Most of us have already come to realize that we mere mortals are but a small bone being chewed on by two very big dogs. The drug companies want to convince you that you need their very expensive drugs and the insurance companies tell you that generics are just fine because they don’t want to pay for the pricey stuff. The real question is who has your best interest at heart? In my mind the only answer is NEITHER.
The drug company that spent $116 million on advertising for Flomax also netted a cool 1.2 billion in sales for that ONE drug in ONE year. The pharmaceutical companies want you to buy there brand name drugs and they charge a huge premium for them. The very name brand drugs that we pay top dollar for in the U.S. are typically sold around the world for much less money. You can buy prescription drugs out of Canada and pay far less for the exact same drug.
Then we have the insurance companies that want to offer you generics because it saves them money. Once the insurance companies have your insurance premiums in their hands they treat it as THEIR money, not yours, and they are very stingy about spending any of the THEIR money on YOUR health.
I have had a recent personal experience with this concept where I was able to save my insurance company thousands of dollars due to my inside contacts and knowledge as I dealt with a family health issue. My health insurance company, whom shall remain nameless, rewarded me by covering less than 10% of my expenses, saying that I went outside of the typical treatment protocol even though I saved them well over $20,000.
When your insurance company saves money by offering you generics, who do you think keeps those savings? Do you think your premiums will go down next year or will there be another million dollar bonus paid to the insurance executive that brokered the deal? I’m left to wonder.
Your doctor can elect to write “DAW” or dispense as written, on your prescription, which will not allow a pharmacist to substitute a generic. But whether your insurance plan will pay for it is another issue.
What’s the best solution? In my mind the best option is to safeguard your health so that you have little to no dependency on prescription medications.
Many don’t like to hear it, but all too often, prescription medication is simply addressing symptoms and not correcting the true metabolic or physiologic issue at hand. Flomax is addressing an issue with urination that is caused by an aging enlarged prostate but it’s not doing anything to effect change in that prostate and has no ability to fix the problem. It’s simply alleviating symptoms. Symptoms that are expected to last forever which is exactly how long they would you like you to continue purchasing their drug. Why don’t we work to actually FIX the real problem?
A change in diet and lifestyle will ultimately be the solution for many medical ailments but physicians are often reluctant to suggest them or are just uninformed on how to make recommendations in this realm. As much as physicians would like to help, the reality is that physicians aren’t taught how to keep people healthy. We are taught disease care employing the use of prescription drugs and surgery. Yes these are valuable tools but they are not the complete answer.
If you are reading this website then I have to make the assumption that you are involved in your own health and take a proactive stance already. Secure the basics of good health: a good sleep cycle, a clean organic diet loaded with vegetables and clean protein sources, drink filtered water, exercise daily and avoid known toxins like plastics as best you can. Sounds boring, but it is the cheapest way around the prescription drug dilemma.
Seek out a clinician or doctor that can help you address your health issues from the inside out and utilize drugs in a very conservative fashion. If you need a drug then take it but don’t stop there. Ask yourself, WHY do I need this drug? What can I do to restore health to my body and reduce my dependency on drug therapy?
I vote for a “brand” new you.
[4 Comments] [4 Comments]
1: BPH is a serious medical condition that can have a significant impact on the quality of life for a man (and wife.) Untreated, it can lead to severe health problems.
2: Where are you paying $248 for a month supply of Flomax? At most, if you are paying cash (with no Rx benefit) you should pay no more than $100 for a month supply of Flomax 0.4 mg/qd. A generic alpha blocker will be $20+ for cash patients. Your price quotes are the absolute highest price for Flomax (rarely seen) and the absolute lowest price for doxazosin (also rarely seen.)
3: While generic alpha blockers are less expensive, they are also older agents, and they can have significant effect on blood pressure. They are considered unsafe for older men to take due to the incidence of orthostasis.
4: ‘Fixing’ the problem of prostatic hyperplasia is also very expensive. Only 5-ARI’s have been shown to reduce the ‘size’ of the prostate, but they are also expensive and have side effects. Surgical procedures (TUNA, TURP, TUIP) are available, but again, price is much higher when the laser/knife come out and hospital stays are required.
4: You only accurate point is in regards to lifestyle modification and health diet.
Hi Erica,
I want to address the questions you raise but I feel it important to state up front that the issues you raised are a bit off point from my original post. I offered a brief discussion on generic versus brand name medication as a response to one of our readers questions. It was not a discussion of benign prostatic hypertrophy (BPH), or a discussion of drug therapy for BPH. You offered many strong statements regarding Flomax and seem to adamantly defend it even though it was not under attack. I simply selected Flomax as an example of a common medication for the purpose of discussion. I could have easily picked an antibiotic, blood pressure medication, or hundreds of other examples. In fact your defense was so focused on Flomax that I was left feeling that perhaps you draw a paycheck in some way from the sale of Flomax? I don’t know what you do for a living but for future reference it would be appropriate to state any financial connection you may have to any product under discussion. This is a non-profit educational health blog and I wouldn’t want to see people using it for personal gain. I am not accusing you of doing this, it’s just the direction of your post seemed odd to me. So lets address your statements.
1: BPH is a serious medical condition that can have a significant impact on the quality of life for a man (and wife.) Untreated, it can lead to severe health problems.
ANSWER: That is true. It’s off point since this was not the thrust or focus of the post you cite but I do appreciate your sharing this. Perhaps it can be the topic of a future post so stay tuned.
2: Where are you paying $248 for a month supply of Flomax? At most, if you are paying cash (with no Rx benefit) you should pay no more than $100 for a month supply of Flomax 0.4 mg/qd. A generic alpha blocker will be $20+ for cash patients. Your price quotes are the absolute highest price for Flomax (rarely seen) and the absolute lowest price for doxazosin (also rarely seen.)
ANSWER: I called two pharmacies in Cincinnati as this is where I live. Walgreens, a nationally recognized pharmacy quoted me a price of $159 for a one month supple of Flomax at a dose of 0.4 mg. CVS, another national chain, quoted me a price of $166 for the same prescription. The manufactures recommended dosing of Flomax is 1 to 2 tablets daily. Since they don’t make a 0.8 mg tablet, if I needed to take 2 Flomax I would be forced to buy 60 of the 0.4 mg tablets so my cost goes up to either $318 at Walgreens or $332 at CVS. So the cost ranges from $159 to $332 depending on pharmacy and dose. Now here is an interesting sidebar that I discussed in my original post. I called two pharmacies in Canada and could buy Flomax 0.4 mg tablets, one month supply for $51. That is the EXACT same drug, dose, and quantity available in Ohio for $159. Now why would Boehringer Ingelheim, the maker of Flomax, charge Americans three times the amount of money it charges Canadians? Are they hockey fans? I can also buy the generic of Flomax, tamsulosin, for just $26, for a months supple of the same thing. I can’t even get that is the states.
You suggest the idea that everyone has health insurance that would cover their prescription but you gloss over a number of facts. Millions of Americans do not have health insurance. That’s why there is all that fuss in Washington these days. With our troubled economy, many have changed or lost jobs and with that change went their health coverage. For those that do have insurance, many have an HSA or health savings account that requires them to pay the first $5,000 out of pocket before benefits kick in. And still thousands if not millions of others have insurance plans that don’t offer brand name drugs to their patients and instead have an “approved drugs” list of generic substitutions and so the only way to get the aforementioned Flomax is to pay out of pocket $159 to $332 per month. But you already know that as you read my original post. So what are we to do all these fine gentlemen? Ignore them? We can’t pretend that everyone fits into one nice box. We have to provide options for every circumstance. Even men that can get Flomax affordably may not react well to it given its numerous side effects such as headache (20%), back pain (8%), dizziness (16%), runny nose (15%), diarrhea (5%), and abnormal ejaculation (13%), and much more. By the way, since you seem to have a close relationship with the Flomax people, would you ask them what “abnormal ejaculation” means? Just reading that gave me the willies.
3: While generic alpha blockers are less expensive, they are also older agents, and they can have significant effect on blood pressure. They are considered unsafe for older men to take due to the incidence of orthostasis.
ANSWER: Yes, they are different agents but there are many that do quite well with the older alpha blockers. Besides, as noted above I can get the generic of Flomax out of Canada and get the exact same drug compound. As I point out above, let’s not kid ourselves into thinking that Flomax is an innocent sheep with no drawbacks. It’s a drug compound that has some benefits for some men but will always be a foreign chemical compound that is attempting to override the body’s metabolic function. It can serve a purpose but the long term solution is to address the bodies altered function. For the record, I use prescription medication in my practice and I know drugs to be powerful agents in helping to improve the health of my patients. But they are also potentially dangerous compounds that must be treated with respect and used wisely. The appropriate use of drugs is still the 4th leading cause of death in this country and so employing other agents such as diet, lifestyle, nutrients, vitamins, herbs can work as safer adjuncts to effect change in a patients condition, lessening their dependence on drug compounds.
4: ‘Fixing’ the problem of prostatic hyperplasia is also very expensive. Only 5-ARI’s have been shown to reduce the ‘size’ of the prostate, but they are also expensive and have side effects. Surgical procedures (TUNA, TURP, TUIP) are available, but again, price is much higher when the laser/knife come out and hospital stays are required.
ANSWER: First of all, the use of a drug compound like a 5-alpha reductase inhibitor is not the only way to reduce prostatic inflammation or size. One of the oldest and best compounds to use is saw palmetto. It’s inexpensive, has the same effect as 5-ARI, is far less toxic and in head to head studies has been shown to be equally effective. In fact, in one large study of 2,500 men suffering from mild to moderate BPH, saw palmetto was compared head to head with tamsulosin (Flomax generic) and finasteride (a 5-ARI) the results showed greater improvement with saw palmetto and there was no negative impact on sexual function as seen with the drug compounds. Vitamin D has been shown to have dramatic impact of prostatic inflammation and even prostatic cancer. I have seen cases of elevated PSA as high as 20 or more, reduce to normal ranges in 4 to 6 weeks with high dose vitamin D. Beta sitosterol, polyphenols, proanthocyanidins, lycopene, and simple zinc have all been shown to decrease prostatic inflammation and size. Simple compounds like fish oil and selenium also reduce prostate inflammation. Why is prostate enlarging in the first place? What about hormone balance, estrogen production or consumption, falling testosterone levels, prolactin levels? Modulating these entities can also decrease prostatic inflammation and size. So lets not dilute this conversation into the notion that the only treatment for BPH is Flomax , especially when Flomax does NOT decrease prostatic size or inflammation. And how did we ever get on the topic of surgical treatment for BPH? Now we are way out of the ballpark onto a totally different topic entirely.
4:(5) You only accurate point is in regards to lifestyle modification and health diet.
ANSWER: As I stated earlier, if you want to engage in an intelligent discussion where the goal is to be respectful of opposing points of view and shed light on a topic so that others can gain insight then I am all for it. Having different opinions is what makes a forum like this educational and beneficial, as we are committed to dispelling myths and half-truths. Look at our mission statement and understand that we want to engage in constructive discussion. But to post the item above is unkind, untrue and inflammatory.
I apologize in advance if my reply appears inflammatory to you. But everything I have stated is true despite your claims of inaccuracy. I hope you continue to visit our site and I love when our readers offer their opposing perspective but it must be done in a mutually respectful environment, otherwise we quickly digress into a bad version of the Jerry Springer show. I look forward to further discussions with you Erica.
Happy Holidays,
Dr. Gary Huber
i have tried saw palmetto , capsules, berry form, 540mg, two 3X daily, but am getting little effect ; is an extract more effective? So, I have resumed taking Flomax brand name .4 ,1x daily. Have been on it three years and having side effects increase….
Hi Phil,
I would start by looking at the source of your saw palmetto. Unfortunately there are many supplement manufacturers in the world and like most things in life there is a range of quality. Where did the raw materials come from, how were they processed, what manufacturing decisions were made with regard to binders and other fillers that effect bioavailability? All of these issues and more go into making a quality products that works. And even then, sometimes the best products don’t give a great result depending on other factors such as your hormonal influences as noted above.
I recommend a good saw palmetto, and to it add a good green tea polyphenol at a dose of 500mg three times a day. Then get your vitamin D level measured and depending on your blood level have your physician guide you in proper vitamin D replacement. I have many men that get great relief on short term high dose vitamin D followed by long term appropriately dosed maintenance. Fish oil is a good anti-inflammatory for the prostate as well.
Have you testosterone, DHT and estrogen levels measured and if there is poor balance then see a physician who is skilled in proper replacement or adjustment. This is the type of work I do in my practice and there many out there like me who understand these delicate hormonal influences.
Lastly, look at your diet and remove overly starched processed foods and the chemicals they contain. Return to a whole foods diet with lots of vegetables. The phytonutrients and anti-oxidants in vegetables, fruits, nuts and seeds and clean meat sources are powerful agents.
As always if you struggle to find the answers you seek in your neighborhood, contact my office for assistance. (Phone# 513-924-5300)
Happy to help,
Dr. Gary Huber