Don't mess with my heart meds!!

I would appreciate some feedback from anyone that cares to respond. I am just fuming with the mail order pharmacy that I have! I had a heart attack in January, and my Doctors prescribed specific medications that I have been taking ever since. Some are monitored to insure the proper dosage, and we make adjustments based on the tests etc. My recovery has been going very well, and I feel great. I only missed three weeks of work following the heart attack, I have lost almost 40 pounds, and I feel much better since the MCI than I did before. Anyway to get to the point. The mail order pharmacy refilled my prescription for Plavix with the generic equivalent and I am incensed! It was cheaper for the Generic ($20 for 3 months), but I don't mind paying more for the original ($60 for 3 months) for what I consider to be one of my most critical medications. When I had the heart attack, they installed a stent into the Left Anterior Descending artery, and Plavix regulates platelets binding together to help with prevent clotting, which could cause a stroke or another MCI. When I called the mail order pharmacy, they said they had no choice that they were required to substitute generics whenever there is one available. I really feel strongly about not rocking the boat. What do you think? Am I over reacting?

:thumbsdow

Hello Mike,

I would have a chat with your cardiologist. It looks like the generic version was just approved this year. You should take some time and review any information you can get so you can be informed.

If you are willing to pay the difference, I see no reason why the Pharmacy wouldn't provide you with the brand you want. Perhaps you should explore the policies of different pharmacies to see if there is one that will meet your needs.

Tom

You must get your doctor to re-write the script and check off the NO SUSTITUTIONS box. This will prohibit them from giving you generic. Your insurance company will be another story but if you paid $60 before it will probably just return to that. Talk to your doctor.

Actually,

The generic has been approved, but there is an injunction to keep anymore from being sold or shipped, unless it has been lifted.

And NO, you are NOT overreacting. You deserve to have the name brand drug if you want it. Don't let the pharmacist tell you that the doctor approved the generic and that's all you can have. You can ALWAYS have the name brand if you are willing to pay the difference.

Bill

My dad had a quad-bypass in may 2005 and used Plavix also.
(he's doing very well).

I did notice he switched to a generic brand also from Brazil...
He did discuss it with his cardiologist and it's fine...

I think it would otherwise get banned or something ?

My 0.02 lumens....
Cheers !

I am with bwaites on this.....what he said. MikeF, funny, My real name is MikeF too. My wife is on Plavix and approved or not, med changes are something that the final decision should rest with the patient and their Doctor. Not some bean crunching numbnuts at the insurance company.

I hope it gets fixed to your satisfaction

While most states permit generic substitution unless the physician specifies otherwise - it was unwise of this pharmacy to change someone on a long-term maintenance medication to a different brand without notice. I'm not terribly familiar with Plavix and how sensitive it might be, but I know there are medications - digitalis preparations, lithium and thyroid hormone to mention three - where patients can experience significant differences between brands and thus should NEVER be substituted without physician consultation and possibly lab monitoring.

The injunction seems to be simply a means for the company to keep charging twice as much for the name.
I'm not aware of any industry, including the medical, where the diference between the name brand and the generic was more than the label and the cost.
If the chemical compound is the same, then the drug is the same. You certainly have the right to pay more for the name but a company offering a service designed to save people time and money does not have to carry specific brands.

Mike you are right, it happens all the time, and is easily taken care of. Don't fume. Remain calm.

ooooooooooooooooommmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm.

ooooooooooooooooommmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm.

ooooooooooooooooommmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm.



Sitting in the Mountains

Rock slab seat
Legs folded
Sitting alone
Not loathing noise
Not savoring silence
The carefree clouds concur.

- Jakushitsu (1290 – 1367)

I also think you are right to be concerned. I have a good relationship with my pharmacist and we take a number of generic drugs. There are also some generics we won't take.

My druggest made the point that while the active ingrediants may be the same used in the name-brand drugs, the binders and other components may be different and this will cause them to work differently for at least some people. It can often be hard enough to coax the advertized performance out of the high priced drugs as many people will react differently to them.

If your insurance is through a managed health organization, like Kaiser Permanente, your prescriptions, examinations, lab work, and most everthing else is handled with them, and according to their rules, standards and your policy. They may use generics as a matter of policy on drugs you have filled at their facitlities, since they supply the prescriptions as part of your policy with them. If that's the case, and you'd rather use a non-generic drug, you can ask your provider for a written prescription and get it filled elsewhere. But, you'll have to pay for them out of pocket.

Mike Painter,

"I'm not aware of any industry, including the medical, where the diference between the name brand and the generic was more than the label and the cost.
If the chemical compound is the same, then the drug is the same."

Simply not true. The FDA allows generics to be "therapeutically equivalent" meaning it has the same amount of active ingredient and can be "reasonably expected" to have the same effect. However, there is a 10% window above and below the name brand that a generic may inhabit. That is effectively a 20% difference in strength possible between 2 generics. It is interesting that once approved a name brand drug MUST remain at the same strength, but generics have that window!

In any given individual, that difference may or may not be a big deal. With drugs where there is a narrow window of therapeutic benefit, such as digoxin, warfarin, thyroid medications, etc. that window is too big. Once a patient is stable on a drug, why risk that change?

That said, the problem is not that generics don't work, they do, of course, but that the switch occurred without the patients consent! That is most definitely NOT OK!!

Bill

My original Plavix was also switched to a generic brand (Clopidogrel) and was told that it was the same formulation and for me worked just the same. However, with my Methadone (it was changed to Methadose) I did noticed a big difference in the way it was absorbed and worked. After getting a new script from my doctor, my HMO finally OK'ed the original prescription. A lot tof times the switch to a cheaper generic brand of meds is not in the patients best interest.

bwaites said:

Simply not true. The FDA allows generics to be "therapeutically equivalent" meaning it has the same amount of active ingredient and can be "reasonably expected" to have the same effect. However, there is a 10% window above and below the name brand that a generic may inhabit. That is effectively a 20% difference in strength possible between 2 generics.
That said, the problem is not that generics don't work, they do, of course, but that the switch occurred without the patients consent! That is most definitely NOT OK!!

Bill

Click to expand...

You'll have to explain how it can have "the same amount of active ingredient"
and still have a difference in strength of up to 10%.

As for the change without the patients consent, I looked into several mail order places before picking one and they all are quite clear in saying that you will get generics when available unless you specifically state otherwise. It is in large bold print in a gray box at the bottom of *every* registration and prescription form from Walgreen's and a Google search yields "It is standard pharmacy practice to substitute generic equivalents for brand drugs whenever possible." on a good number of insurance and pharmacy forms.

Mike,

Meds can be mixed with any of multiple approved binders and colors. Some of those binders might/can block absorption of the medication. While I once thought that those who claimed some generics weren't as effective as the name brand drug were just overly suspicious, I now have seen it in too many patients to believe otherwise. Even in patients who had a HUGE financial incentive to use a generic, but were willing to pay more for the name brand.

This is most glaringly obvious in the Oxycontin abusers, who theoretically should want the cheapest drug, because that allows them to buy more. BUT, there is almost NO illegal market for generic Oxycontin, because the abusers readily recognize that the name brand is more potent, even at the same strength.

It might be even more deadly if you happen to receive a medication mixed with an FDA approved color that you happen to be allergic to. Lets say it's FDA yellow #3 and it is mixed with FDA red #5 to make an orange pill. Would you recognize that the orange might contain something you are allergic to?

All that said, the big complaint here is that the substitution was made without consultation with the patient.

If I change a patient's meds without telling him, I am guilty of malpractice, because there is no "Informed Consent" to the change. If a pharmacist that doesn't even know the patient, hasn't seen him, may not know what other meds he is taking, has no way of knowing his true allergies, and is sometimes 3000 miles away does it, it's OK?

Regardless of the legalese that some "mail order pharmacies" put out there to limit liability, changing any medication without consultation with the patient should be illegal, and although it is not, it is bad medicine and unethical.

I thank all of you for your insight and information. I just got off the phone with a "Medication Counselor" at Medco, my mail order pharmacy. After some discussion, she agreed to replace the generic with Plavix. It helped to know that there is a judge that has ordered the distribution of the generic to be stopped as of last Thursday, September 1. She told me that it was a judges opinion, not a Medical professionals, and that they stood behind the generic. She said they always substitute generics for existing prescriptions. I insisted that they were changing the medication without my permission or prior knowledge. She said they issued a new prescription for the generic, and I said that just strengthens my position that they were changing my medication without my permission. She put me on hold and when she got back on the phone she agreed to send me what I had requested September 23, i.e. the medication that was ordered for me by my Dr. They are sending a return mailer as well so I can send them back the generic. I hope they are disposing of the generic rather than sending it to someone else. I now have to make an appointment with my Dr., just to have him make sure all of my meds are marked "no substitute" or "no generic". She admitted it was just to save themselves money.

So what if a few patients have reactions or possibly worse, they saved money!

Glad to see you got your meds straightened out.

Excuse my probable ignorance in these matters but aren't all generics supposed to be exactly the same as the original? For instance aren't the cheap drugstore brand 200mg ibuprofen tablets excatly the same as the Advil ones? Is this not always true?

No and No.

There can be variations in fillers, binders, coloring, size, coatings, etc.

The FDA says that generics must be essentially the same, but there is variation allowed as explained above.

Bill

The big problem here is that you are caught between the two most powerful lobbies in Washington; the insurance companies, who want cheaper prices so they can make a bigger profit, and the drug companies, who want higher prices, so they can make more money.

At least the drug companies provide a tangible benefit when they make more money, they invest in research so they can make more new medications, thus making more money.

When insurance companies make more money, they just pay their management more! (Most health insurance companies are "non-profits" so the stockholders that would make money from greater profits don't exist. Since they are non-profits, they have to do SOMETHING with that money!)

It's not quite as simple,cut, and dried as I make it sound, but after 10 years on the insurance companies side, I went into medicine, so I have a somewhat unique perspective!

Bill