Pharmacists may be switching your meds

[batman]

Laws allow substitution of generic drugs without patient knowledge
By Richard Laliberte

When you hand a pharmacist a prescription, you expect to get the medication your doctor ordered. But because of a perfectly legal loophole in rules that govern how drugs are dispensed, you may not — and the consequences can be dire.
Just ask Amy Detrick of Grove City, Ohio.
For months after the former social worker, 40, was diagnosed with epilepsy, her doctor fine-tuned the precise cocktail of meds that would keep her from having seizures...(more)

[Junebug]

This article really makes me sick cuz I've had the same thing happen to me after my pharmacy did this to me with my Lamictal last summer.
I ended up having 10x's as many tonic clonics and one night ended up in the er with 5 staples in my head, not to mention the headaches 24/7 when I started the generic drug.
As soon as my dr noted the change he put me on the brand name and I went down to 1 tonic clonics a month and no headaches at all.

I have fought with my insurance co. about the increase in cost since it's out in generic and they kept saying that I could appeal it but that it wouldn't change anything. I ended up canceling my ins and getting an ins. with a pharmacy co-pay when I purchase brand name drugs.

The bad thing about this though too is that most pharmacists will dis-agree with the article that generics and brand names are exactly the same when they aren't.

[BIGMAN131307]

You can blame the pharmacists, but they are only partially to blame. The insurance companies are the ones to thank for the medicine swapping. They want to limit everyones medical expenses by using as many generics as possible.

There are two ways around this. The first is if there is no generic available, then they have to pay for the name brand. If you pay a co-pay that's up to your insurance company. The second is if your Neurologist or other doctor writes DAW on your prescriptions. That forces the insurance companies to allow the pharmacists to give you the name brand drugs. The insurance companies may or may not pay for the drugs.

In my situation my anti-epileptic drug Trileptal has been switched multiple times. When I first started on it I got the name brand. But a refill later I was getting a generic. It seems every other refill the pharmacists switched generics. They switched to save the insurance company mere pennies. None of them seemed to help me any more or less.

So I decided to have my neurologist order Trileptal on my prescriptions DAW. At first he tried to talk me out of it. My neurologist told me that the generics are allowed to be at most 15% different than name brands. But most are 5-8%, and there is 3-5% difference between generics. So swapping generics for other generics should not matter. But I explained my concerns about the anti-epileptic drug generic swapping. My neurologist finally agreed to write DAW. I did have to pay a co-pay for my prescription. But I still got the name brand. When I first started name brand I had a couple complex partial seizures that day. I believe the change caused those complex partial seizures. IMHO I believe the name brand is working better. But it has only been less than a month. So I will have to wait a few months to decide if the DAW worked for me.

[Junebug]

You can blame the pharmacists, but they are only partially to blame. The insurance companies are the ones to thank for the medicine swapping. They want to limit everyones medical expenses by using as many generics as possible.

There are two ways around this. The first is if there is no generic available, then they have to pay for the name brand. If you pay a co-pay that's up to your insurance company. The second is if your Neurologist or other doctor writes DAW on your prescriptions. That forces the insurance companies to allow the pharmacists to give you the name brand drugs. The insurance companies may or may not pay for the drugs.

In my situation my anti-epileptic drug Trileptal has been switched multiple times. When I first started on it I got the name brand. But a refill later I was getting a generic. It seems every other refill the pharmacists switched generics. They switched to save the insurance company mere pennies. None of them seemed to help me any more or less.

So I decided to have my neurologist order Trileptal on my prescriptions DAW. At first he tried to talk me out of it. My neurologist told me that the generics are allowed to be at most 15% different than name brands. But most are 5-8%, and there is 3-5% difference between generics. So swapping generics for other generics should not matter. But I explained my concerns about the anti-epileptic drug generic swapping. My neurologist finally agreed to write DAW. I did have to pay a co-pay for my prescription. But I still got the name brand. When I first started name brand I had a couple complex partial seizures that day. I believe the change caused those complex partial seizures. IMHO I believe the name brand is working better. But it has only been less than a month. So I will have to wait a few months to decide if the DAW worked for me.

This is where I am at with my Lamictal. My insurance co had to pay the brand name price (70/30 copay) until the generic Lamotrigine came out last summer. Since the generic wasn't working for me, I had to go back on the brand name and now have to pay 50/50, no matter if my Dr. writes brand name medically necessary, brand name only or DAW. My ins. doesn't care so they just lost our business yesterday for the last time. (My new ins started yesterday.)

[alivenwell]

Wouldn't it be great if we all located appropriate drug insurance companies? The non-drug insurance could be carried by another company. Let's face it. If we get the right medication, then those hospital visits may be reduced. Wouldn't that make a lot of sense?!

[forward2007]

I went to the pharmacy to pick up my Topamax and they gave me the generic without me even knowing it. Not long after that, my Dr. started me on Lamictal and he didn't even try and prescribe the brand name because there is a generic available.

[Meetz1064]

I've had a seizure med as a generic , I seize, and the pharmacy knows it. As it is a smaller chain of supermarket stores, it fears the lawsuit that I could potentially slap them with. So, the solution for me, as well as others that can only use brand name that they know about is to give us the brand name, without ever subbing, but having us sign a slip of paper acknowledging that we have specifically asked for it, and so has the doctor. WHOOPEE. A slip of paper versus NO SEIZURES. Hmmmmm.

[skillefer]

I guess I'm lucky...my neurologist wrote DAW on my prescription without even asking me, when he switched me over to Dilantin. He said he doesn't trust generics because although 20% may not matter to some people, 20% difference can mean a huge difference in seizure control.

Alivenwell: totally agree. You'd think that insurance companies would be more proactive...hmm, give them the right med and not pay for a trip to the ER and all the tests that that includes....but then again, common sense is not that common.

[Loopy Lou]

I didn't realise there was actually a difference in generic/brand name except the price.

They have the same amount of the drug don't they? or is it just extra stuff the generics have added into them? I'm on generic lamotrigene, but i'm likely to change to another drug soon.

[batman]

With the help of topix.net, I came across an article, titled ‘Pharmacists may be switching your meds’. I don’t know how long the article will remain online, so hopefully, for those of you who are reading this posting will be able to read the article.

While reading over the article I started to remember a particular topic that was discussed during an epilepsy conference that I had attended several years ago. But I just could not remember a particular word that was used in that topic. So with the help of me taking notes during that epilepsy conference, and copying those notes to my computer, I was able to locate that particular word that I was trying to remember. And that word was, Bioavailability.

The issue with generic medications is known as bioavailability, which is the amount of medication available for your body to absorb. The bioavailability of the medication has to be plus or minus a certain percentage of the bioavailability of the name brand drug. That “certain percentage” was something else I could not remember, but I did know that percentage had been increased by the FDA. So I did some online searching by using the word ‘bioavailability’ and it appears that that certain percentage had been increased to roughly 20%.

Now, for some people with epilepsy, but not everyone with epilepsy, that plus or minus 20% might not be such a big deal. However, for many of the other individuals who have epilepsy, and this does include people who might have their seizures controlled with brand-name antiepileptic medications, if the brand-name medication is switched over to a generic medication, the bioavailability of the medication could vary, and the person’s blood level could very as well, which could result into problems either with toxicity or breakthrough seizures. Would you be willing to take the risk in order to find out if you, your loved one, and/or someone else you know who has epilepsy, might have these problems? I’m not.

The generics can save you money, but the question is... “Where does your pharmacist get their generics?” Let’s say for example, a pharmacist is getting low on one of their generic antiepileptic medications, and company ‘A’ is having a special on their generic antiepileptic medications. Where's your pharmacist most likely going to get their generic antiepileptic medications? Yes, most likely from company ‘A’. Then later on, another company, company ‘C’ comes in and says, “Listen, if you buy this much product from us, we’ll give you and your spouse a free weekend in Hawaii.” Where do you suppose your pharmacist is most likely going to get their generic antiepileptic medications this time? Yeah, company ‘C’. So do you suppose the bioavailability of company ‘A’s’ generic is going to be the same as the bioavailability of company ‘C’s’ generic? Probably not. One potential problem with generics is that pharmacists are probably not consistently buying from the same generic supplier.

One advantage of brand-name drugs is you always know what you are getting. And to get these brand-name drugs, usually there are two lines on the physician’s prescription pad. One says, ‘Dispense As Written’ (DAW), which means the pharmacist has to fill the prescription exactly as the doctor has written it. Then there's another line that they can sign that says, ‘Substitutions Permitted’, which means the pharmacist does not have to give you the name-brand drug. So if you're one of the individuals who needs or wants the brand-name drugs, then you want to make sure the prescription is signed by the physician on ‘Dispense as Written’.

Going back to when I was searching online in order to find out what the results would be when using the word ‘bioavailability’, the links I’ve included below are to a few websites that came up in the search results. And each of those 3 articles include the word and explanation for the word ‘bioequivalence’. I would highly recommend for everyone to read these articles because what is mentioned in them might be very helpful when dealing with generic antiepileptic medications, pharmacists, financial assistance, and or trying to maintain control, or a enough control, for your or someone else’s seizures.

Generic Drugs: They Save Money. But, Are They Effective and Safe?

The Epilepsy Battle in the War Between Brands and Generics

... And just as a heads up, some of the words that are used in this next article, are not clean words.

Brand Name Medications vs. Generic Drugs: The Differences Are Real.

[skillefer]

Lou, generics can contain anywhere from 80%-120% of the active ingredient in the brand name and even between batches...For some people, that's just enough difference to cause seizures.

[Junebug]

Lou, generics can contain anywhere from 80%-120% of the active ingredient in the brand name and even between batches...For some people, that's just enough difference to cause seizures.

Also, because of the difference of active ingredient between brand and generics your body won't metabolize it the same, therefore it doesn't go through your system exactly the same.

[batman]

Here is a copy of the reply I posted on a yahoo support group for epilepsy, which I wanted to share with everyone.

That is correct, Pat, I am not a pharmacist. And apparently, neither are you. My “assumptions and speculations about Pharmacists”, along with my “remarks about Pharmacists switching from one generic company to another” are based on the notes I took from what I had recorded while attending a Seizure and Epilepsy Program presentations. And with the speaker being a neuropsychologist, who brought this to everyone’s attention who attended, plus the information that’s being discussed in numerous articles and individual stories concerning people with epilepsy, apparently there is a difference between ‘name brand antiepileptic medications’ and ‘generic antiepileptic medications’.

I agree that most consumers are adept at pursuing their prescriptions prior to submitting them, as well as consumers checking their pill bottles before they exit the store to ensure that they paid for the correct product. I also agree and continuously understand that meds are approved by the high standards of the FDA, along with my understanding that most major insurance companies will only pay for generics. Congratulations on your Dad being a Pharmacist for over 45 years. However, with everything you said in your reply, nothing answers the question “Is there a difference within the bioavailability of the name brand antiepileptic medications and the generic antiepileptic medications, even if the generics have the same name but are manufactured by different pharmaceutical suppliers?”

Here’s some more information that was mentioned during the same Seizure and Epilepsy Program presentations. The chemical that does the work in the name brand antiepileptic medications and the matching generic antiepileptic medications, are the same drugs. For example, the chemical in Tegretol that does the work is called carbamazepine. In the generic Tegretol, the chemical that does the work is carbamazepine. Do you hear any difference in the chemical that’s used for either of these drugs? No. In Depakote, the chemical that does the work is sodium valproic. In generic Depakote the chemical that does the work is sodium valproic. Do you hear any difference in the chemical that’s used for either of these drugs? No. In Dilantin, the chemical does the work is Phenytoin. In generic Dilantin the chemical that does the work is Phenytoin. Do you hear any difference in the chemical that’s used for either of these drugs? No. There is absolutely no difference with the name of the chemical that does the work, in either the name brand or the generic brand antiepileptic medication. So the person’s body is getting the same chemical.

Now let me use another example, and this is going to be one I’ve thought of myself, concerning ‘Chocolate Cakes’. Let’s say a person goes to a grocery store and sees a variety of Chocolate Cake mixes. For starters, those chocolate cake mixes would not be on the store shelves unless they had been approved by the Health Department. Out of all of the chocolate cake mixes, several have been manufactured by different name brand companies, and there are a few other chocolate cake mixes that were manufactured by separate generic companies. The prices for the name brand chocolate cake mixes are most likely going to cost a bit more than the generics. However, for each of those individual chocolate cake mixes, each one will most likely contain the same ingredients of flour, sugar, cocoa, baking soda, and possibly some salt. Some of the ingredients that might need to be added could be eggs, butter or margarine, milk, oil, and or water. If we follow the instructions in order to make each chocolate cake separately, and then complete the baking process, a few of the chocolate cakes might appear to be similar to one another, but a few other chocolate cakes might look a bit different. Either way, no matter how you look at the cakes, they’re all still going to be called chocolate cakes.

Now, what do you suppose the likelihood is going to be for each of those individual chocolate cake mixes containing the exact same amount of flour, the exact same amount of sugar, the exact same amount of cocoa, and the exact same amount of baking soda? Highly unlikely. A couple of the chocolate cake mixes might contain the exact same amount of one or more certain ingredients. But I seriously doubt that every one of those chocolate cakes mixes are going to have the exact same amount of matching ingredients.

All of the individual chocolate cakes might look the same just by looking at them, and the FDA and certain insurance companies may add icing to the cake simply because they either don’t understand, don’t care, and or really don’t want to get too involved; What matters most, is what’s inside. What did it take, and exactly how much of that did it take, in order to make each one of those individual chocolate cakes? Then the next important question could be, for everyone who reads this reply, do you suppose everyone would be able to handle a same sized individual slice of every one of those chocolate cakes, without having any problems? My guess is that most people might be able to do this without having any problems, but there may also be just a few people who might experience some type of allergic reaction and/or side effect they cannot withstand.

Prior to creating this reply, I came across an article that was recently placed online, and after I read over the article, there were several lines that stood out. The first was, “...in the case of many neurological disorders, especially epilepsy, switching from a brand name to a generic or between generics can be extremely dangerous”; “...variants can mean the difference between a normal, seizure free life and dealing with the risk of breakthrough seizure’s, brain damage and even death.”; and lastly, “No cost is too great when it comes to your health.” That article is titled, ‘In the Case of Epilepsy, Generic Drugs and Random Product Substitution are Not Always “Good Medicine”’, and it's currently at, http://www.engelpub.com/News/Index.c...icleid=629553#

[Junebug]

Well said Bruce!

[jimmy williams1]

You are right on with your description . We went to the generic because of insurance . Our experience witrh the generic has been very negative . I have been very skeptical of changing back , but the evidence is clear . The generic is causing headaches , exhaustion , and a state of dreaminess . We are going to pay out a small fortune to get the original , but we have no choice .

[skillefer]

hey jimmy!! have you tried asking your neurologist to get a waiver from the insurance? They can.. And since your had negative issues with the generic, they can request the waiver due to medical necessity.

[alivenwell]

I recently did some research on fillers as well. On foods (like chocolate cake), the ingredients are listed from a highest quantity to a lowest quantity. And, personally, some cakes are better than other cakes.

On drugs (brand and generic), fillers are listed in alphabetical order. This is where it hurts us. We have every right to know which filler went into that medication and how much of that filler was used when creating it.

With that knowledge, we could find the 'right' prescription that closely matches what works and keep that generic company or that brand name company medication. It invokes competition for the extremely expensive brand name drug companies. Pharmacies carrying high quality generics could retain faithful customers. It's a win-win situation.

The part that bites is the fact that trademarks are involved between expensive brand name drugs and various generic drug companies. The fillers, and their quantities, are considered proprietary information.

If I had a way of knowing which fillers closely matched what worked for me, I'd probably pick the cheapest. Now, I obviously don't intend to make a copy of my drug, but once I buy it, isn't it considered my 'property'? And, don't we all deserve to know which proprietary mix is being dispensed at the drugstore? I'd love to get them at a cheaper price, but I'm not settling for a second rate medication that doesn't work.

[doclotus]

Yeah, I got "lucky" and caught my pharmacy in the middle of trying to switch me to a generic without asking. They were low on the generic and were trying to do a partial fill. I instructed them to use the brand name and they almost refused.

The part about switching generic manufacturers without notice really ticked me off.

It costs more, but Keppra has kept me seizure free from Day 1. Maybe it isn't the Keppra, but I definitely don't consider it worth the risk. Luckily, my neurologist agrees and puts DAW in big bold letters now.