Who gets to choose?

March 10, 2008 at 10:12 pm | Posted in Rants | 3 Comments

Even though I haven’t lived in Houston for almost a decade, it is still home and I regularly read the local paper online. Recently I read an article about generic drugs that struck a nerve with me.

Toward the end of last month I took a new prescription to the pharmacy closest to work to have it filled at lunchtime. I’ve had some occasional prescriptions filled there (antibiotics for a sinus infection, etc.) and didn’t have any major complaints…although I definitely wouldn’t have raved about the customer service either. I went there because it is the closest to work and there is another location of the same chain near my home. I considered waiting, but it was going to be at least half an hour, so I said I would come by after work to pick it up.

When my physician wrote the prescription, she made a point of saying that she did not want me on the generic version because she has had patients have trouble with the generics of this particular medication in the past. No one asked about generic vs name brand when I turned the prescription in, and I didn’t realize it was going to become a huge issue. I had a late meeting at work and made it to the pharmacy 30 minutes before closing. I was sick, tired, and just wanted to get home.

After paying for the Rx, the pharmacy tech handed me the bag. At this point I noticed that the name on the bag was not the trade name for the medication, it was the generic name. I said that my physician did not want me on the generic version. I was told that because she did not check either the line next to “Do not substitute” or the one next to “substitution permissible” they had no choice but to fill it with the generic version. I was given no other option but to take the paper prescription back to her office and have her sign her name next to the “Do not substitute” line. Getting the refund for my co-pay would fill a post of it’s own, so I’m not going to get into that. Trust me, it was not fun.

I don’t know if pharmacy standards are that different here compared to where I’ve lived before or if the people at this particular pharmacy are just all jerks, but this really bothered me. I’ve been told before that there has to be pre-authorization from the insurance for the trade name or that the co-pay would be higher, but I’ve never been told that the pharmacy wasn’t “allowed” to fill the prescription with the brand name version. Even worse than that, they didn’t ask or tell me anything about what was happening. They just filled the prescription with the generic version. If something had been said when I turned the prescription in, they could have communicated with my physician during normal business hours or I could have taken the prescription somewhere else. None of this happened though and I left without the medication.

The next day I called my doctor’s office and she called the prescription in to a different pharmacy, specifying no generic substitution. They filled the prescription with no problems and I was charged the exact same copay as the first pharmacy had tried to charge. Clearly something hinky is going on at pharmacy #1, and I won’t be taking anymore prescriptions there, even if it is more convenient!

This whole episode bothered me for several reasons. First, I don’t understand when it became the pharmacist’s right to decide what medications I am “allowed” to buy when I have a valid prescription from a licensed physician. I can understand if they tell me that my insurance won’t cover a certain medication or that the co-pay is higher…that kind of thing happens. But I was told I couldn’t fill it with the brand name AT ALL. To me, this kind of decision shouldn’t be made by the pharmacist. They don’t know my personal medical history, the exam and lab test results that led to the physician writing the prescription, or quite a bit of other pertinent information.

Even without my physician saying she didn’t want me on the generic version, I had some concerns because the quality control on some generic medications just isn’t good. The article I linked to earlier discusses some of the circumstances that contribute to this problem. For example, American drug manufacturers are supposed to be inspected by the FDA every two years. There is no similar regulation for foreign manufacturers. According to the article, last year only 13 out of 700 Chinese factories that are known to manufacture medications sent to the US or ingredients to be included in medications sold in the US were inspected. I don’t know about you, but this really concerns me given the recent problems with lead paint, dog food and heparin from China that have been all over the news. The article also linked to a website called “The People’s Pharmacy” that has some information about potential problems with generic medications and a forum for people to post comments about problems they have experienced….and yes, one of the medications my physician didn’t want me to take a generic version of is listed as having problems by several different posters.



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  1. Oh great, one more thing for me to worry about! I think most of what we take is generic except for Junior’s Nexium. I better start reading up on this!

  2. Some medications seem to be more problematic than others with the generics. However, I googled several different medications taken by either family or myself and found that there are quite a few out there with “reported issues” with the generics. Part of the problem is that generics can be manufactured by more than one pharmaceutical company, while trade names aren’t. The generics sometimes end up varying based on manufacturer with a generic from one company working for a person while a generic from another won’t.

  3. An important issue for us all. Unfortunately, most people only think “cheap” not “quality.”

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