Squiggles on a paper, dashed off by the doctor and, miraculously, decipherable by the pharmacist.
Birth control. Prenatal vitamins. Blood pressure pills. Some 27 million Americans (or more) on antidepressants.
I dare say that a large percentage of us are taking a prescription for something, and we count on its effectiveness. We routinely pick up a new script, drop it at the local CVS or Walgreen’s, pop our pills when needed, and get on with the business of daily living.
We don’t think twice about trusting what has been prescribed. I know I haven’t.
But short of allergic reactions and initiating a request for a prescription change, one of the things we don’t expect is a pharmacy switching out the manufacturer of our meds, specifically when we’re taking generics because money is tight and we’re trying to save a few bucks.
If a generic-for-generic substitution takes place, the pharmacy generally doesn’t inform us. Best I can tell, they aren’t required to, and we never think to ask.
Until we get sick.
Then again, the dispensing of generic versus brand-name pharmaceuticals is an area that is governed by state law. For instance, I found this consumer information on generics for the state of New York.
Tales From the Unknown?
About two weeks back, a friend of mine found herself depressed, anxious, and generally under the weather. She couldn’t figure out what was wrong, and eventually, she looked to a medication she’d been taking for years. Fortunately, she hadn’t tossed the info sheet that accompanied her latest bottle of pills.
The manufacturer had changed, and she was experiencing a variety of side effects – including panic and depression – something that had never happened previously.
She tried repeatedly to get the pharmacy to offer an alternative – preferably the pills she used to take, or at the very least, another recommendation from the doctor. The situation escalated, and she eventually wound up in the emergency room incurring $150 in cost, after days of being sick and unable to work (affecting her income).
Might I add that this woman has no medical insurance? Needless to say, she’s changed pharmacies.
I’ve lived through this scenario myself, when a routine medication I’d taken for years simply ceased working. I went for two weeks before it occurred to me to check the prescription. I talked to the pharmacist, who confirmed that the manufacturer had indeed changed. I was more fortunate than my friend; they acted swiftly to special order my former generic medication, which they graciously and carefully do, each time I need a refill.
Problem solved.
But I now check any medication for consistency of manufacturer.
Problem Pills, Problem Procedures
So where was the breakdown for my friend, who is now feeling better, but went through a harrowing experience at considerable expense?
Please note – I am not in the medical profession, but after a little research, confirmed by a discussion with my own pharmacist, here’s the gist of generic-to-generic substitutions as I understand it, in my state:
- The pharmacy is not required to explicitly inform you of a substitution of one generic for another, though some may do so. If you check your information sheet or prescription packaging, you will note the name of the manufacturer, and when it has changed.
- The pharmacy is required to provide counseling with regard to dispensing medications, for example interactions and possible side effects. They ask if you need the counseling, and you sign off on receiving it or declining it.
- When it comes to generics, the active ingredients must meet the same requirements in clinical trials, but patients may indeed react differently to a substitution from one generic to another. This is hard to predict, and is patient-specific.
- Examples? Medication delivered through a patch that doesn’t adhere to the skin as well as another can deliver less of the active ingredients, or for a shorter period of time. Or, the way a pill dissolves on your tongue (which involves inactive ingredients) may render it less effective than a pill which is more dense.
- Read your labels. Note your generic manufacturers. Pay attention to any side effects or unexpected problems. Talk to your doctor and talk to your pharmacist.
I will reiterate what I have said before – we own our bodies, and we must educate ourselves as health care consumers. I can’t tell you how many times SSRIs have been thrown into the mix as an easy out for an unrelated problem, and without mention (by the physician) of possible side effects.
That said, doctors are only human, are often caught between a rock and a hard place with regard to insurance companies and their own time crunch, and our culture is increasingly accepting of (scared into?) a pill for every ill. (Discussion for another day.)
As for my pharmacy, they are a consistently excellent resource, but I accept that we will not be handed every piece of information we may need. Ultimately, we’re responsible for participating in this process, these days more than ever. And that includes paying attention to the pills we pop – a lesson I learned the hard way, as did my friend.
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I always check and when they tried to switched to generic I call my pharmacy and the pharmacist said that indeed if I had been taking the non generic for 18 years he advised no switching to generic. I got the prescription for the non generic and they told me they would keep it on file so I would never get the generic. Other drugs started with generic should be checked as well and my pharmacy always notifies me that the color has changed and the pill is from a different manufacturer. All this from my online healthcare pharmacy for Blue Shield.
Doctors are not gods and they make mistakes. I once was given a medicine and 6 weeks later something was really wrong. I was in the 5% that got a reaction. Thank goodness I called when the weirdness started they weaned me off. He wrote it all over my chart. I, of course, have forgotten what the drug was but they remind me when I come to see the doctor. Having worked for doctors for 15 years I have learned one must have an advocate if not capable of doing it on their own.
With unemployment rates at all time highs, with healthcare and insurance costs on the rise, and with fewer medications covered by insurances, it is easy to opt for the cheaper Generics. Even if it is a change that we are aware of, it is a choice many make. There is a reason that Generic brands are often one fourth the cost of the manufacturers brands. We are not talking about name brand ketchup vs generic, medications change the makeup of our physical biology.
It is a bit disheartening that they can change on you without consent but how many of us actually know what it is we are taking when it is not generic? Do we not trust our physicians and pharmacists blindly? (as in your previous post)
I think it is time we all took a little more accountability and interest in what is going into our bodies, be it prescriptions, fast food or alcohol and tobacco. It is time we take care in the prevention rather than the reaction when something affects us.
Such important advice here. Thankfully I am a person on few medications (just prenatal vitamins for now) so this isn’t something that affects me much. However, I am probably just the type of person to get into a bind due to my lack of experience navigating the pharmaceutical world. Thanks for sharing your experience and that of your friend. I will bear this in mind in the future, to be sure.
Gale, Madge, NAS – Thank you for joining in. Part of the problem may be “we don’t know what we don’t know.” We also need to get out of the habit of not questioning so-called authority figures. They can’t possibly think of everything, any more than we can legislate everything. Meanwhile, the more we can learn – including the necessity to ask for additional information – the better.
But how often does this sort of thing go on? And of course, there’s no recourse for my friend – and the lost dollars during that period of time, much less the out-of-pocket cost.
Happened to me and I remember it like it was yesterday, not 12 years ago. Suzy (wife and nurse) figured it out. I now require my physicians to post to each prescriptions, substitutes NOT allowed. Simple fix… So simple it should be the default?
Fantastic idea, Gandalfe!