Question about colonoscopy kits?

[Pharm113]

Is Gavilyte N and Trilyte both the generic of nulytely? If a doctor writes for nulytely would giving gavilyte N or trilyte be okay? It kind of confuses me that they seem like a brand by the name so with the generic substitution. Also, in this case is Gavilyte N and Trilyte interchangeable or MD would need to be notified if you change between them. Anyone in retail help me out? Thanks.

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[zelman]

Those are branded generics.

Branded Generics
A Branded Generic is simply a drug that is bioequivalent to the original product, but is now marketed under another company's brand name. Branded generics are an attractive business for Valeant’s Emerging Markets operations as they enjoy low research and development costs and sustainable sales in that have already faced the patent expiry of traditional pharmaceutical compounds.

They are AA rated

A Drug products that FDA considers to be therapeutically equivalent to other pharmaceutically equivalent products, i.e., drug products for which:

(1) there are no known or suspected bioequivalence problems. These are designated AA, AN, AO, AP, or AT, depending on the dosage form; or

(2) actual or potential bioequivalence problems have been resolved with adequatein vivo and/or in vitro evidence supporting bioequivalence. These are designatedAB.

​

They are the last two listed here: (...though I don't know why Gavilyte-N is listed with the generic name, it is the product made by Novel listed below)​

POLYETHYLENE GLYCOL 3350; POTASSIUM CHLORIDE; SODIUM BICARBONATE; SODIUM CHLORIDE FOR SOLUTION;ORAL

AA LAX-LYTE WITH FLAVOR PACKS
PADDOCK LLC

AA NULYTELY
+ BRAINTREE

AA NULYTELY-FLAVORED
+ BRAINTREE

AA PEG-3350;POTASSIUM CHLORIDE;SODIUM BICARBONATE;SODIUM CHLORIDE
MYLAN 420GM/BOT;1.48GM/BOT;5.72GM/BOT;11.2GM/BOT

AA PEG-3350;POTASSIUM CHLORIDE;SODIUM BICARBONATE;SODIUM CHLORIDE
NOVEL LABS INC 420GM/BOT;1.48GM/BOT;5.72GM/BOT;11.2GM/BOT

AA TRILYTE
MEDA PHARMS 420GM/BOT;1.48GM/BOT;5.72GM/BOT;11.2GM/BOT

 

[Pharm113]

So in this case does it mean you can switch from gavilyte n to trilyte or other way without consulting w md? Are they treated as generic? Or do you still have to go with the peg 3350?

 

[BidingMyTime]

So in this case does it mean you can switch from gavilyte n to trilyte or other way without consulting w md? Are they treated as generic? Or do you still have to go with the peg 3350?

AA rated means they can be switched without consulting the physician (unless your state has some strange law otherwise.) All that matters is they are AA rated, it doesn't matter if they are plain generics or branded generics.

 

[PharmdA07]

As a CYA, I've and would always call. I've been asked by the board inspector on AB-rated drugs that needs to be called for approval on switching to generic (!!). Plus it's only about 5 minutes for "Is it OK to give them the generic Trilyte because their insurance only covers this generic?" and 98% of the time the answer would be "Yes". I once had a Gastro told me "As long as he **** completely, I don't care!" LOL

 

[zelman]

As a CYA, I've and would always call. I've been asked by the board inspector on AB-rated drugs that needs to be called for approval on switching to generic (!!). Plus it's only about 5 minutes for "Is it OK to give them the generic Trilyte because their insurance only covers this generic?" and 98% of the time the answer would be "Yes". I once had a Gastro told me "As long as he **** completely, I don't care!" LOL

You have 5 minutes extra in your day for every generic substitution?

 

[Wheresmyaricept]

I actually had to research the difference between all the bowel preps for one of my rotations.

They have the exact same amount of ingredients in them and are AA rated so they can be substituted.

If you were to change Gavilyte-N to Gavilyte-G, I would call because they have different amounts of electrolytes in them. According to my preceptor at the time who had a masters in something relevant that I can't remember, different amounts of electrolytes light up differently on different colonoscopy machines. I can't actually confirm if that's true because I'm too lazy to look it up and contrary to popular belief, staring up people's buttholes is not my area of expertise. But he sounded like he knew what he was talking about.

 

[Dred Pirate]

"Is it OK to give them the generic Trilyte because their insurance only covers this generic?" and 98% of the time the answer would be "Yes". I once had a Gastro told me "As long as he **** completely, I don't care!" LOL

This is what annoys me about our profession - we all know these things are virtually the same, there is never any clinical reason to choose one over the other 99.999999% of the time, yet we have to call and get permission? With 8 years of edcuation, can't we just make a clinical decision? (That is one of the driving factors why I will always stay in hospital vs retail is that I can do things like that without calling and annoying the doc - because believe me, they do get annoyed and most would be more than happy to just let us change. I wish they would just write -"bowl prep- whatever is covered buy ins" - and do this for a variety of drug classes (PNV's, renal vitamins, PPI, H2's, etc)

 

[zelman]

This is what annoys me about our profession - we all know these things are virtually the same, there is never any clinical reason to choose one over the other 99.999999% of the time, yet we have to call and get permission? With 8 years of edcuation, can't we just make a clinical decision? (That is one of the driving factors why I will always stay in hospital vs retail is that I can do things like that without calling and annoying the doc - because believe me, they do get annoyed and most would be more than happy to just let us change. I wish they would just write -"bowl prep- whatever is covered buy ins" - and do this for a variety of drug classes (PNV's, renal vitamins, PPI, H2's, etc)

H2's? Randomly swapping between Ranitidine and Tagamet might create some drug interaction problems. (Consider the snowbird who goes to a different pharmacy every other 6 months)

 

[Dred Pirate]

H2's? Randomly swapping between Ranitidine and Tagamet might create some drug interaction problems. (Consider the snowbird who goes to a different pharmacy every other 6 months)

In this case I would hope a pharmacist would be smart enough to never start someone on tagament (hence why we went to school for 6-8 years)

 

[PharmdA07]

This is what annoys me about our profession - we all know these things are virtually the same, there is never any clinical reason to choose one over the other 99.999999% of the time, yet we have to call and get permission? With 8 years of edcuation, can't we just make a clinical decision? (That is one of the driving factors why I will always stay in hospital vs retail is that I can do things like that without calling and annoying the doc - because believe me, they do get annoyed and most would be more than happy to just let us change. I wish they would just write -"bowl prep- whatever is covered buy ins" - and do this for a variety of drug classes (PNV's, renal vitamins, PPI, H2's, etc)

I know it's the story of retail. I used to resent that but after a while practicing, I've come to accept the reality. I've realized that the ultimate goal is to get the most clinically appropriate and affordable medication for my patients and to ensure their understanding of how/what they are taking. To achieve that, I don't mind jumping through hoops or getting yelled at (provided that these things don't get past my limits). As long as my patients get what they medically need, I don't care what these docs think! As far as the permission and formality of calling for substitution, it's just our intrinsic setting and legal obligation that restrain us and force us to follow the norms. To quote my dad "it's what it is, so stop whining and start doing!"
These things are the reason why I keep my sanity loving my other job at the hospice facility where I have more autonomy adjusting pain n/v meds or antibiotics and deciding appropriate routes of admin.

 

[PharmdA07]

You have 5 minutes extra in your day for every generic substitution?

LOL no not really ! I don't have 5 minutes for every single substitution. However, with things like these and birth controls, or Narrow therapeutic meds (e.g. generic of transplant/ psych/ seizure meds etc.), I usually find time to do what I need to do to protect my license--it's really is CYA if you think about it.

 

[npage148]

If something is AB rated I will never call which is legally allowed by the FDA and lower state laws so I don't need to cover my arse

 

[owlegrad]

Dear god please do not call for AA or AB rated substitutions (stupid negative formularies notwithstanding of course).

 

[Ackj]

I wish they would just write -"bowl prep- whatever is covered buy ins" - and do this for a variety of drug classes (PNV's, renal vitamins, PPI, H2's, etc)

Theoretically sounds good, but insurances probably wouldn't like it. Kind of like "test strips - 100 count" doesn't go over very well.

 

[sakigt]

I actually had to research the difference between all the bowel preps for one of my rotations.

They have the exact same amount of ingredients in them and are AA rated so they can be substituted.

If you were to change Gavilyte-N to Gavilyte-G, I would call because they have different amounts of electrolytes in them. According to my preceptor at the time who had a masters in something relevant that I can't remember, different amounts of electrolytes light up differently on different colonoscopy machines. I can't actually confirm if that's true because I'm too lazy to look it up and contrary to popular belief, staring up people's buttholes is not my area of expertise. But he sounded like he knew what he was talking about.

I thought they were just replacing the electrolytes youre poopin' out.

 

[Dred Pirate]

Theoretically sounds good, but insurances probably wouldn't like it. Kind of like "test strips - 100 count" doesn't go over very well.

so, I don't work retail, but when I used to, I would get those scrips and just fill with what they were on before, if they were new, I would pick one that I liked. Can you not do that anymore?

 

[Wheresmyaricept]

I thought they were just replacing the electrolytes youre poopin' out.

That's what I thought but he said he talked to one of the local docs and that's what they said. It's not really a topic I cross too often so I don't care to research it. Like I said--I'm lazy.

 

[DelPharm]

H2's? Randomly swapping between Ranitidine and Tagamet might create some drug interaction problems. (Consider the snowbird who goes to a different pharmacy every other 6 months)

If you're randomly switching people to Tagamet, it's time to give your license back.

 

[BidingMyTime]

I would never call on an AA/AB rated substitution, there is no legal or therapeutic reason to do so, a complete waste of time....the sole exception would be if I thought the physician had made an error (ie the patient had been on DAW-1 Coumadin for the past year, and the new RX said substitution allowable & the pt aid the dr hadn't talke to him/her about changing to the generic.)....but then I would call for any unusual change in a patient's prescription that the pt hadn't been told by the doctor about.

 

[RX2090]

This is what annoys me about our profession - we all know these things are virtually the same, there is never any clinical reason to choose one over the other 99.999999% of the time, yet we have to call and get permission? With 8 years of edcuation, can't we just make a clinical decision? (That is one of the driving factors why I will always stay in hospital vs retail is that I can do things like that without calling and annoying the doc - because believe me, they do get annoyed and most would be more than happy to just let us change. I wish they would just write -"bowl prep- whatever is covered buy ins" - and do this for a variety of drug classes (PNV's, renal vitamins, PPI, H2's, etc)

It's not so much asking for permission versus letting the prescriber know what you want to do. Yes, we know enough to make the switch ourselves. But don't you think the prescriber has a right to know that you are changing the medication, however small it may be? If he wrote nasonex, and only Flonase is covered, obviously it's a no brainer. But as the prescriber, it's his right to be informed.

It's all about how you approach it. If you call the doctor and say "insurance doesn't cover nasonex. May I please switch to Flonase?" Is wrong and makes you look bad. If you call and say "hey doc, his insurance only covers Flonase, just wanted to call you and see if we can switch it." Sounds much better.

 

[Dred Pirate]

It's not so much asking for permission versus letting the prescriber know what you want to do. Yes, we know enough to make the switch ourselves. But don't you think the prescriber has a right to know that you are changing the medication, however small it may be? If he wrote nasonex, and only Flonase is covered, obviously it's a no brainer. But as the prescriber, it's his right to be informed.

It's all about how you approach it. If you call the doctor and say "insurance doesn't cover nasonex. May I please switch to Flonase?" Is wrong and makes you look bad. If you call and say "hey doc, his insurance only covers Flonase, just wanted to call you and see if we can switch it." Sounds much better.

I actually disagree with your second part - I always tell my students/new hires that you can't call a doc and just say "you can't do this" you ALWAYS have to give an alternative. I personally thing the first line sounds better, but that is just my two cents worth