Your doctor has given you a prescription. Now, you’re at the pharmacy.
You’re told that you can choose between the name-brand medication and its generic equivalent. If you’ve got insurance, there’s only a small price difference; if you don’t have insurance, the prices are a bit farther apart. How much farther apart, exactly? The FDA says that, on average, generic drugs are 80 to 85 percent less expensive than their name-brand counterparts. Viagra, one of the most popular name-brand drugs, costs about $25 per 50-milligram tablet. Sildenafil, a generic alternative, costs less than $4 per 20-milligram tablet (recommended dosages vary between the two medications). Given that information, it shouldn’t come as a surprise that nearly 8 out of 10 patients opt for the generic drugs. In 2010, these consumers saved about $158 billion—an average of $3 billion per week. As the FDA notes, cheaper doesn’t mean lower quality, but there are key differences between generic and brand-name prescriptions.
Contrary to popular belief, generic drugs don’t use different active ingredients.
The FDA requires generic medications to have the same active ingredients, strength, route of administration, and dosage as name-brand medicines. While the administration allows some small variances in purity, these are carefully controlled. Generic drug manufacturers are allowed to have different inactive ingredients. Of course, inactive ingredients are just that—inactive. They are only present to hold the medication together while it does its job. Furthermore, the FDA monitors generic drugs closely, looking for “adverse events” that might imply an issue with the medication’s formula. That means that if a generic isn’t working as it’s supposed to, the administration will step in to force a change. Name-brand drugs face the same high level of scrutiny, and they’re no more likely to have major variances in efficacy, patient comfort, or other important factors.
There is one important caveat to consider.
While the FDA requires drugs to be “biologically equivalent,” it allows some room for interpretation. The agency has a “bioequivalence range” of 80 to 125 percent. Does this mean that generic drugs meet FDA requirements if they’re only 80 percent as effective as the alternatives? No, not quite. As the FDA says on its website, “There will always be a slight, but not medically important, level of natural variability—just as there is for one batch of brand name drug compared to the next batch of brand name product.” In theory, generic drugs could be more than 80 percent dissimilar, but they would still have to contain the same active ingredients and present the same results in patients. Thanks to rigorous monitoring from the FDA, ineffective drugs don’t make it to market. Some generics may even work better than branded drugs for some patients. Still, that’s what the FDA says. What about what patients say?
Some patients claim that name-brand drugs are more effective, but the science doesn’t back that up.
Numerous studies show that generic drugs are just as effective as branded drugs. A survey of 2,070 studies from 1996 to 2007 showed an average difference in absorption of less than 3.5 percent. This wasn’t always in favor of branded drugs, as some generics were absorbed more readily. However, the small degree of difference is what’s most important; the FDA notes that the differences “would be expected and acceptable, whether for one batch of brand-name drug tested against another batch of the same brand, or for a generic tested against a name-brand drug.” This is even true for biologics, a relatively new class of medications made from living cells. While scientists were initially concerned that biologics couldn’t be replicated as easily as other medications, a 2016 study from the Johns Hopkins Bloomberg School of Public Health found that generic alternatives to a popular biologic drug were just as safe and effective.
So, why do some patients claim that certain branded drugs are more effective?
In some cases, they are more effective—for those patients, anyway. The minor differences in inactive ingredients might prompt a significant metabolic change for the individual. Once again, this is highly unlikely, but it does occur on occasion. Even so, the more likely answer is the placebo effect. Changing from a purple pill to a dull blue pill could convince some patients that they’re getting a less effective drug. Doctors are often careful to point out the identical active ingredients, but even so, the placebo effect is a powerful thing. Here’s how powerful placebos can be: In one study, Dr. Ted J. Kaptchuk presented half of a group of IBS patients with a placebo, telling them that the drug wasn’t functional, while the other half of the group received nothing at all. The placebo group experienced noticeable improvements in their symptoms, despite the fact that they knew that they weren’t receiving a real drug.
Even if your insurance makes the price difference negligible, there’s a reason to go generic.
Let’s assume that your insurance provider covers most of the cost of your prescription. In fact, we’ll even assume that you’d pay the same co-pay, regardless of whether your drug is generic or brand name. Generally, you should still choose generic. You’re only seeing part of the price, and the rest of the expense is passed on to your insurance provider. If you receive medicine at a hospital, the hospital may also cover some of the cost. In either case, you’re helping to drive up the cost of health care, and your insurance provider will likely pass on the expense to other customers. This is part of the reason that insurance premiums have soared over the past several decades. Of course, that doesn’t make you a bad person if you opt for brand-name prescriptions, but remember: They contain the exact same active ingredients.
The bad news: some drugs don’t have generic alternatives, mainly due to patent protections.
Patents protect drugs for 20 years, and they’re awarded to the original drug manufacturer. They protect against generics that offer the same mechanism of action, and brand-name manufacturers can essentially charge whatever they’d like. Because drugs take a tremendous amount of money to develop, drug companies keep their prices high, and generic manufacturers are forced to sit on the sidelines waiting for their turn to sell drugs to consumers. The tradeoff is that generic drugs can drastically undercut their competitors when they finally make it to the market. You can find out whether your prescription drug has an approved generic alternative by checking out the Orange Book, which is maintained by the FDA. There are also downloadable apps on the Apple App Store and on the Google Play store, although the simplest course of action is to simply ask your pharmacist.
Ultimately, you should talk to your doctor before switching from any medication.
Generic drugs are less expensive, and purchasing them can help to drive down costs in health care. If you’re picking up a new medication and you’ve got a choice, they’re almost always a smarter purchase. The FDA agrees, even if some pharmaceutical companies disagree. But there’s one thing that doctors, drug manufacturers, and the FDA all agree on: Don’t trust the internet as your sole source of medical information. While generic drugs are usually a much better choice, your physician and pharmacist can help you determine whether you should switch medications. In particular, you should take care when switching medications for mental disorders, as variances in inactive ingredients could potentially have profound effects. Not to belabor the point, but this isn’t likely; the drugs are usually identical, but there’s no harm in consulting with a doctor before making the change.