Doctors who get pharma money prescribe brand-name drugs instead of generics


If you bother to look at the rules of most Health Insurances they require the dispensing of Generic (regardless of what the doctor prescribes) If one is available. If the doctor ticks the Dispense As Written then it is the doctor who overrides this rule based on his knowledge of that patient’s particular needs. In this new age of Federal oversee of doctors they are required to do things this way.


I think it depends upon insurance plan and your own company’s formulary. Generally, a doctor’s Rx as written (do not substitute) will work, although sometimes the doctor will have to justify the brand by letter/appeal. I once had my husband’s employer, which was a newspaper, deny an appeal because ultimately they’d have to pay more. I spoke to this very nice HR person and argued that the newspaper had often written articles critical of insurance companies second-guessing doctors. She got my denial changed and I got the drug that worked best for me. I sent her flowers the next day.


Often, the best thing to do would be to ask your doctor and your pharmacist about generics. For some drugs they’re exactly the same, for others there may be legitimate differences. For example, a drug might be active only if the molecular structure has a right-hand turn. The brand name drug might be 100% right-handed, but the generic with the same molecular formula could be 50-50 left vs right so you’re effectively getting half the dose.


With a generic name like that, I don’t see how a brand name could compete. Especially with street dealers*, their work is practically done for them!

*I have no idea whether anesthesia meds have street uses…


Anything that alters consciousness is abusable, but the various drugs that send you to sleep need someone (like me) who knows what they’re doing to supervise. So abusing them is very unwise and users tend to die relatively soon after starting (Michael Jackson being a case in point).

Sugammadex doesn’t do anything much to your brain. It just mops up a drug that paralyses muscles and prevents it from working. So I can render someone quickly and totally paralysed with one syringe, then reverse it completely with Sugammadex in another, all within a minute. That’s actually useful, so it’s magical stuff. Yet still too expensive for routine use as Merck are milking it for all it’s worth. Very cool when there’s an excuse to use it though.

Ketamine and most opioid drugs have street value and can be used directly. Ephedrine can be used as a chemical precursor for crystal meth, so there is a street market value in that too. We keep all those drugs double locked up, with a log book that needs 2 signatures to account for use and ampoule numbers are independently checked against the log at the beginning and end of each shift.

In a previous job in a city with a very big drug problem, I was told that hospital sharps bins have a street value. Presumably for the once-used needles and syringes with the dregs of drugs left in them. :anguished: :astonished:


I’ve spent enough time reading shampoo bottles on the toilet to know that they only ever say, “rinse and repeat if necessary.” :smile:

That being said, you’re mostly right, though I’ve learned through experience that this does not generally hold true for store-brand food products.


This is not the case in the United States, at least. Per the FDA, drugs have to be bioequivalent to be sold as generic. If one is optically pure, and the other is racemic, they are not bioequivalent. There is no way you’re selling something with a different optical composition without a whole new round of clinical trials.


same on the other side of the pond. EU’s EMA demands bioequivalence studies for generics.


So, one of my very good friends is a licensed pharmacist. I’ve talked to her about generics, and generally, yeah, the brand name is a huge waste of money. As mentioned earlier though, this isn’t always the case, as generics just need to be in a specific range to qualify.

For example, people seem to be very sensitive to drugs like Ritalin and Adderall, so on those drugs… you do not want to be messing with people’s meds. For some reason with those it seems like at least for some people the brand name works significantly better than the generics.


this is most likely related to the medication adjustment, done with more care and time early in the treatment (so more likely with the original drug). when switching to cheaper generics the medication is less intensive adjusted and the patient can experience a worse efficacy.


I think it’s more than that. She said some people can do better on the generics too, it just depends on the person. A friend of mine tried a generic form of ritalin, had issues with it, was given the brand name, did… much much better, then without his consent they switched him back to a generic… bad things again. There’s something about the way those drugs interact with your brain that it seems like there’s just enough difference in the generics to make them work differently.


Sure, the (non-drug) fillers have an impact and no one should underestimate the placebo effect* - not relevant for the approval, but the human body is a curious machine (see also the different anecdotes in the MSG thread).

*) short psychiatry story: a patient was accustomed to one sort of placebo/sugar pills with a very distinct form. the pharmacy was not able to provide the pills any longer and the replacement just did not work; the patient explained vehemently and violently that the new medication is harmful


Yeah I believe it :slight_smile: Placebos are incredible and amazing things (At least the way our brains respond to them is pretty amazing!).


Where’s the war Doctor!!!

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