Prasco Zyprexa and Greenstone Geodon...

[WVUPharm2007]

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...don't work as well as the brand. Or so the nutty patients we have claim.

It never ends, does it? Telling them its made in the same damned factory doesn't seem to matter. It says its generic, ergo, it can't work as well.

I'm still waiting for the day someone tells me their generic works better than their brand. You'd think it would happen to someone...yet, it never does. Amazing that instant release molecules manufactured on incredibly accurate machinery work that way.

An entire population of people...conditioned to the point of psyching themselves into thinking a "generic" med isn't as good that they actually think it works differently.

And its always the psych meds...Greenstone Zoloft, too...good god...that one was the funniest one...people swearing up and down they are having more panic attacks because of the Greenstone generic. Do people not notice its the same color, shape, size, and the side of the bottle says that Greenstone is a wholly owned subsidiary of Pfizer?

I'm waiting until they start manufacturing some of the brand psych meds in India like what AstraZeneca did to brand name Toprol after switching from Swedish manufacturing plants. I guarandamntee you that nobody will all of a sudden think their drug made in a completely different factory is working any different. Because its brand.

They just need to make the entire concept of brand names illegal. Just a chemical name, that's it. Pfizer brand sertraline. Exclusive for 21 years. That's it.

 

[Ackj]

They just need to make the entire concept of brand names illegal. Just a chemical name, that's it. Pfizer brand sertraline. Exclusive for 21 years. That's it.

I have thought that for a while. What's the point of it anyway? Would be less medication errors too, since no brand/generic and fewer look alike/sound alike.

What's the threshold for generics anyway, isn't it like +/- 10% of the brand strength? You'd have to figure that there are just as many on the high end than the low end, so the generic could end up getting you a bigger dose if you're willing to wager it.

 

[All4MyDaughter]

What's the threshold for generics anyway, isn't it like +/- 10% of the brand strength? You'd have to figure that there are just as many on the high end than the low end, so the generic could end up getting you a bigger dose if you're willing to wager it.

Incorrect.

 

[All4MyDaughter]

More info...

To be approved for marketing, a generic drug must demonstrate therapeutic equivalence to its brand-name counterpart, be manufactured under the same strict standards of good manufacturing practice regulations, and meet the same batch requirements for identity, strength, purity, and quality as required for brand products.2,21-24

There is a common misconception that generic drug levels or bioavailability may vary up to 20% from brand. The misconception generally stems from not understanding the statistics involved in evaluating bioequivalence. In reality, the bioavailability of most generic drugs differs from their brand-name counterparts by less than 4% in the U.S.

Although there are anecdotal reports of adverse effects when patients switch from brand-name drugs to their generic counter parts, there is no proof that therapeutically equivalent (i.e., AB-rated in U.S.) drugs would differ in efficacy. Keep in mind that generic products are only tested against the brand product. Therefore, in the U.S., AB-rated generics may not be significantly different from the brand, but there is no testing to prove that they are bioequivalent to one another.

Generic substitution with therapeutic equivalent products generally saves patients a substantial amount of money without adverse effects. In rare cases, adverse effects have been noted when a generic product is used in place of the brand product (e.g., allergies to inactive ingredients, etc). In these cases, an authorized generic or branded generic (the actual brand-name drug product relabeled and marketed under a generic product name), if available, can be considered.

 

[joetrisman]

More on bio-equivalence from a paper I wrote (this is a paraphrase from the orange book):

"Bioequivalence pharmacokinetic evaluations of brand to generic are carried out with a two-treatment crossover study design with approximately 24 to 36 volunteers. Single doses of the reference and generic drug are assigned to volunteers with blood levels tested. Area under the curve (AUC) and peak drug concentration (Cmax) are compared between the generic and reference medications in a generic to brand ratio test substitution that must >=80% and a brand to generic test substitution that must be <= 125%. The statistical tests are usually carried out using analysis of variance (ANOVA) along with the calculation of a 90% confidence interval for Cmax and AUC"

 

[pion]

I've long had the suspicion that these kinds of situations are more common with psych meds because much of their "effectiveness" is placebo effect anyway.

 

[Ackj]

More on bio-equivalence from a paper I wrote (this is a paraphrase from the orange book):

"Bioequivalence pharmacokinetic evaluations of brand to generic are carried out with a two-treatment crossover study design with approximately 24 to 36 volunteers. Single doses of the reference and generic drug are assigned to volunteers with blood levels tested. Area under the curve (AUC) and peak drug concentration (Cmax) are compared between the generic and reference medications in a generic to brand ratio test substitution that must >=80% and a brand to generic test substitution that must be <= 125%. The statistical tests are usually carried out using analysis of variance (ANOVA) along with the calculation of a 90% confidence interval for Cmax and AUC"

Between 80 and 125% with 90% confidence interval is much more lax than the 4% A4MD claims. If testing AUC and Cmax, and not outright tablet dosage, you're bound to have more patient to patient variability anyway.

 

[owlegrad]

Between 80 and 125% with 90% confidence interval is much more lax than the 4% A4MD claims. If testing AUC and Cmax, and not outright tablet dosage, you're bound to have more patient to patient variability anyway.

Wouldn't the cross-over design solve that problem?

 

[xiphoid2010]

people are forgetting something from their P1 "pharmaceutical manufacturing" class: dosage uniformity. Even the brand name drug, the manufacturing standard allows variation in active ingredient between 2 pills up to +/- 25%. But the standard deviation needs to be less than that, I think it was 6%.

It in the US pharmacopeia somewhere. And no, I'm not going to dig up notes from 5 years ago.

 

[joetrisman]

This convo reminds me of absolute risk reduction vs relative risk reduction.

 

[MountainPharmD]

You should see it from my end. I think it it truly shows that none of these psych medications actually work. Its the placebo effect. Because they are taking something they feel better.

Within days of the Lexapro generic launch we were flooded with brand penalty requests for people who couldn't take the generic because it didn't work, Really? After less than a week?

Lipitor, Plavix all the same crap. As soon as the generic comes out here come all the BS requests for Brand Penalty overrides. It makes my stomach upset, my toenails itch, my hair hurts when I take the generic. Bunch of bullcrap if you ask me. Yet we have all these dumb ass doctors who fill out the forms and put these BS reasons on there. Then they complain about how terrible and unneccessary we are. They prove to me everyday why we are there and necessary.

 

[rxlea]

This convo reminds me of absolute risk reduction vs relative risk reduction.

You're knee deep in stats right now aren't you You sure you don't want to apply to my grad program? Your ability to think in stats will make you fit right in 😛

 

[joetrisman]

You're knee deep in stats right now aren't you You sure you don't want to apply to my grad program? Your ability to think in stats will make you fit right in 😛

I'm still brushing up on my stats. I've taken regular stats, biostats, managerial stats, but I still wouldn't call myself very able with stats. I'm reading Intuitive Biostatistics: A Nonmathematical Guide to Statistical Thinking right now in preparation for rotations in case any preceptors try to get the jump on me Well, that and my two projects.

Grad school is my fall back if I can't get a residency or a job. I dunno about outcomes research though. I've always wanted to study epidemiology 😍 My outcomes research elective got cancelled! My teacher is leaving 🙁

 

[rxlea]

I'm still brushing up on my stats. I've taken regular stats, biostats, managerial stats, but I still wouldn't call myself very able with stats. I'm reading Intuitive Biostatistics: A Nonmathematical Guide to Statistical Thinking right now in preparation for rotations in case any preceptors try to get the jump on me Well, that and my two projects.

Grad school is my fall back if I can't get a residency or a job. I dunno about outcomes research though. I've always wanted to study epidemiology 😍 My outcomes research elective got cancelled! My teacher is leaving 🙁

You're better off than I am lol I feel like an idiot sometimes when I'm around the other grad students.

Sorry about your elective 🙁

 

[Dr Wario]

I had a patient tell me that brand orthotricyclin made her sick while the generic trisprintec did not. She had medco and her copay for the brand was actually much less than the generic ($8 for brand, $25 for generic). We went back and forth on this for awhile, but she eventually had to make due with the brand...

 

[MountainPharmD]

What I have learned at the PBM.....generics do not work! They cause, face swelling, eyes glued shut, nausea, blurred vision, palpitations, sweaty palms, muscle aches, weakness, extreme tiredness, nervousness, insomnia, hypersomolence, irratic lab values, changes n personality, increased anxiety, and a million other horrible things that do not happen when you take the brand name.

 

[farmadiazepine]

We need a mandatory generic substitution rule. All medications in the state are to be dispensed as a generic, unless the MD writes DAW 1 on the Rx. This way, there is no more "I need brand" bullshi*.

I am tired of this nonsense, especially with all the authorized generics out there for so many medications.

I'll be a dick to people behind their backs. We filled watson atorvastatin for a couple back in December. They come to the register, make a scene asking WTF is THIS? Where is MY LIPITOR? I told him it was the same thing, nope they didn't buy it. So instead of paying $30 for generic, I switched it on the computer, stuck onto the SAME bottle a nice label that read "Lipitor" instead of "Atorvastatin: Generic for Lipitor". They paid $60 for that label.

The public needs to be educated, its supposed to be our jobs to educate them, but after I've tried SO many times, there are just stubborn, dumbas* people who don't want to listen. For them, just give them what they want, and get them out.

The only people who can really educate these people are someone like Dr. Oz whose on TV. Pharmacists can't do shi*. When you explain to these people that when they go to the hospital, they will never get the brand, only the cheapest generic the hospital can afford, nope, they won't listen.

I wanna smack these people every day of my life.

 

[owlegrad]

We need a mandatory generic substitution rule. All medications in the state are to be dispensed as a generic, unless the MD writes DAW 1 on the Rx. This way, there is no more "I need brand" bullshi*.

That's no problem, they can just get the doctor to write whatever they need to on the rx.

 

[smercer]

Don't worry...Someone will get standardized Healthcare in place. Then you can bet your sweet *$$ the Gov aint gonna be paying for Brand names and everyone will only get Generics covered, unless they want to pay out of pocket for their Brand names.

 

[pezdispenser]

We need a mandatory generic substitution rule. All medications in the state are to be dispensed as a generic, unless the MD writes DAW 1 on the Rx. This way, there is no more "I need brand" bullshi*.

Some states already have this, such as Florida. Something along the lines of "the pharmacist shall substitute for the generic unless..."

 

[joetrisman]

Some states already have this, such as Florida. Something along the lines of "the pharmacist shall substitute for the generic unless..."

Orange book state?

 

[amox]

America is all about brands...

Reminds me of the time I was at the mall, the sales lady asked if I wanted to buy my female companion a Coach purse. I told her no, we use plastic walmart bags. Appearance doesn't matter, only function.

I look clean in my white tee. The clothes do not make the individual.

 

[rxlea]

America is all about brands...

Reminds me of the time I was at the mall, the sales lady asked if I wanted to buy my female companion a Coach purse. I told her no, we use plastic walmart bags. Appearance doesn't matter, only function.

I look clean in my white tee. The clothes do not make the individual.

I disagree. In professional settings, it's important to look more coach than plastic bag. An example-- people do notice if your shoes look old/worn. And girls notice everything...are your fingernails tidy? Are your clothes ironed? Are your grays showing? Does your purse/handbag match your outfit?

Appearance definitely matters. It's exhausting and expensive to look good but I think somewhere in the subconscious mind, we judge the character of an individual by how they look. It's why sales people wear suits and the like.

 

[joetrisman]

I disagree. In professional settings, it's important to look more coach than plastic bag. An example-- people do notice if your shoes look old/worn. And girls notice everything...are your fingernails tidy? Are your clothes ironed? Are your grays showing? Does your purse/handbag match your outfit?

Appearance definitely matters. It's exhausting and expensive to look good but I think somewhere in the subconscious mind, we judge the character of an individual by how they look. It's why sales people wear suits and the like.

+1

Deep down, everyone is at least a little snobby on the inside 😛

 

[rxlea]

+1

Deep down, everyone is at least a little snobby on the inside 😛

Agreed. I think our level of snobbiness changes with the situation, too. Like...date vs work vs conference vs school whatevs.

 

[Wheresmyaricept]

I'll be a dick to people behind their backs. We filled watson atorvastatin for a couple back in December. They come to the register, make a scene asking WTF is THIS? Where is MY LIPITOR? I told him it was the same thing, nope they didn't buy it. So instead of paying $30 for generic, I switched it on the computer, stuck onto the SAME bottle a nice label that read "Lipitor" instead of "Atorvastatin: Generic for Lipitor". They paid $60 for that label.

Maybe I'm reading this wrong...but did you charge them for Lipitor and dispense Atorvastatin?

 

[All4MyDaughter]

Maybe I'm reading this wrong...but did you charge them for Lipitor and dispense Atorvastatin?

Yes, it came up in another thread as well. It's misbranding, kids. Don't try this at home.

 

[MountainPharmD]

Yes, it came up in another thread as well. It's misbranding, kids. Don't try this at home.

Back when I was at Safeway they were running reports on generic verse brand purchases of Protonix and comparing it to sales reports. I heard through the grapevine someone was fired for ordering four times more generic than brand yet sales reports showed they sold four times more brand than generic.

 

[WVUPharm2007]

Back when I was at Safeway they were running reports on generic verse brand purchases of Protonix and comparing it to sales reports. I heard through the grapevine someone was fired for ordering four times more generic than brand yet sales reports showed they sold four times more brand than generic.

But if you owned an independent...

...eff it, I'd do it.

 

[joetrisman]

But if you owned an independent...

...eff it, I'd do it.

I'll be sure to consult you when I'm taking business ethics next quarter

 

[cycloketocaine]

We need a mandatory generic substitution rule. All medications in the state are to be dispensed as a generic, unless the MD writes DAW 1 on the Rx. This way, there is no more "I need brand" bullshi*.

I am tired of this nonsense, especially with all the authorized generics out there for so many medications.

I'll be a dick to people behind their backs. We filled watson atorvastatin for a couple back in December. They come to the register, make a scene asking WTF is THIS? Where is MY LIPITOR? I told him it was the same thing, nope they didn't buy it. So instead of paying $30 for generic, I switched it on the computer, stuck onto the SAME bottle a nice label that read "Lipitor" instead of "Atorvastatin: Generic for Lipitor". They paid $60 for that label.

The public needs to be educated, its supposed to be our jobs to educate them, but after I've tried SO many times, there are just stubborn, dumbas* people who don't want to listen. For them, just give them what they want, and get them out.

The only people who can really educate these people are someone like Dr. Oz whose on TV. Pharmacists can't do shi*. When you explain to these people that when they go to the hospital, they will never get the brand, only the cheapest generic the hospital can afford, nope, they won't listen.

I wanna smack these people every day of my life.

That was a stupid move.

 

[pezdispenser]

Misbranding AND insurance fraud. Even switching one generic manufacturer for another is wrong, because at least in my state, you are required to put the correct generic manufacturer's name on the label.

 

[Farmercyst]

That was a stupid move.

X^2. Posting it in the public domain.

 

[ancienbon]

We need a mandatory generic substitution rule. All medications in the state are to be dispensed as a generic, unless the MD writes DAW 1 on the Rx. This way, there is no more "I need brand" bullshi*.

I am tired of this nonsense, especially with all the authorized generics out there for so many medications.

I'll be a dick to people behind their backs. We filled watson atorvastatin for a couple back in December. They come to the register, make a scene asking WTF is THIS? Where is MY LIPITOR? I told him it was the same thing, nope they didn't buy it. So instead of paying $30 for generic, I switched it on the computer, stuck onto the SAME bottle a nice label that read "Lipitor" instead of "Atorvastatin: Generic for Lipitor". They paid $60 for that label.

The public needs to be educated, its supposed to be our jobs to educate them, but after I've tried SO many times, there are just stubborn, dumbas* people who don't want to listen. For them, just give them what they want, and get them out.

The only people who can really educate these people are someone like Dr. Oz whose on TV. Pharmacists can't do shi*. When you explain to these people that when they go to the hospital, they will never get the brand, only the cheapest generic the hospital can afford, nope, they won't listen.

I wanna smack these people every day of my life.

On time one called me and asked for brand name for tylenol with codeine elixir. When i told them, they would get the generic whenever they go, they said they got the brand name at the hospital. lol.
One time a patient wanted brand name of lortab,and i told him that his doctor wrote for the generic . He asked me to transfer it to cvs, which i did . I knew for sure he would get the generic as he has medicaid. Called cvs a few days later, and they said he got the generic.
One patient who was taking generic vicodin for quite a while, and decided to try the brand name. A few days later, i asked her how is the brand name working for her .She asked me if i really gave her the brand name, as she did not notice any difference. lol

 

[Farmercyst]

I disagree. In professional settings, it's important to look more coach than plastic bag. An example-- people do notice if your shoes look old/worn. And girls notice everything...are your fingernails tidy? Are your clothes ironed? Are your grays showing? Does your purse/handbag match your outfit?

Appearance definitely matters. It's exhausting and expensive to look good but I think somewhere in the subconscious mind, we judge the character of an individual by how they look. It's why sales people wear suits and the like.

A plastic bag is obviously not a professional appearing purse, but otherwise everything else you mentioned can be accomplished with Wal-mart-ware. You don't need Armani, coach, dolce, or rolex to be professional in appearance. A little starch is far less expensive than exhorbitantly priced cotton, wool, silk, etc.

 

[All4MyDaughter]

But if you owned an independent...

...eff it, I'd do it.

And your pharmacy might end up like one of our local competitors... raided by the Feds for investigation of Medicare fraud.

Not worth it.

 

[rxlea]

A plastic bag is obviously not a professional appearing purse, but otherwise everything else you mentioned can be accomplished with Wal-mart-ware. You don't need Armani, coach, dolce, or rolex to be professional in appearance. A little starch is far less expensive than exhorbitantly priced cotton, wool, silk, etc.

It can. Mostly. I think it's easier for guys though. WalMart doesn't have the best business attire collection for women. Then there is matching... that's why Ross is awesome. Cheap and wide assortment of brands...lesser known and more expensive. A.little something for everyone.

 

[Farmercyst]

It can. Mostly. I think it's easier for guys though. WalMart doesn't have the best business attire collection for women. Then there is matching... that's why Ross is awesome. Cheap and wide assortment of brands...lesser known and more expensive. A.little something for everyone.

I do like Ross for bargain shopping. Dress shirts especially.