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.
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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