Q. What’s your opinion of insurers switching from brand name to generic drugs? -Jeff

Hi Dr. Huber,
I was wondering if you have an opinion about “therapeutic switching” which if I understand it correctly is what happens when insurers or pharmacists decide that you’ll get a generic instead of your prescribed drug because it’s cheaper. I have seen this story over the past few days and wondered if you had an opinion about it. Thanks! Jeff

Hi Jeff,

You raise a great question. Brand name versus generics. Theoretically there shouldn’t be a great difference 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 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? 

Good luck to you,

Dr. Gary Huber