A pharmacist explains where generics come from, how they can cost so much less, and whether they’re really just as good as their brand name counterparts.
Beth Levine,Mar 3, 2020 • 4 min read
If you think brand name meds are the only way to fill your prescription, think again. In fact, according to the U.S. Food and Drug Administration (FDA), nine out of 10 prescriptions are filled for the generic version of a drug. It’s a good thing, too. With medication costs continuing to skyrocket, generic drugs can provide consumers with some serious savings. A 2019 report by the Association for Accessible Medications reveals generic drugs have saved the U.S. healthcare system $2 trillion in the last decade, generating $293 billion in savings in 2018 alone.
But don’t just take our word for it, the pros agree. “I strongly recommend that patients start out on generic medications or switch to generic if it’s available, as they almost always work as well as brand name drugs,” says C. Michael White, PharmD, professor and head of the Department of Pharmacy Practice at the University of Connecticut. “Why throw away an extra $30 to $50 per month to get a brand name when the generic will give you what you need for a fraction of the cost?”
Here, we clear up the top five questions about generic medications—including how they can be so cheap in the first place—so you can see if switching your prescription is a possibility.
Are brand name and generic forms of a drug really the same?
In short, yes. “Brand name drugs usually get a seven-year period of exclusivity before a generic is allowed on the market,” says Dr. White. “One generic manufacturer gets a brief time of around six months to be the only generic before things are opened up more broadly to other companies.” In order to get approved, generics must have the same active ingredient and achieve the same blood concentrations as the brand name drug they are replicating, but their inactive ingredients (such as special coatings, flavorings, preservatives) can be different. The FDA’s Office of Generic Drugs (OGD) undertakes a rigorous review of every generic prior to market release. The generic drug needs to achieve 10 percent above or below the blood concentrations reached with the brand name for the FDA to approve the generic. (They typically only vary by 3 to 4 percent up or down.)
Why are generics so much cheaper if it’s really the same as the brand name?
You are not paying for the brand name’s research and development on the actual drug (as well as the earlier versions that failed in trials), or for the marketing and advertising that got consumers and clinicians aware of the brand name drug. You’re simply paying for the medication itself, the end result, and this consequently lowers the overall price.
I switched to a generic but it’s not working. What should I do?
It’s possible that you may have a negative reaction to the inactive ingredients, or the compound just doesn’t work as well for your unique makeup. Talk with your healthcare provider about substituting another generic (if there is one) before going back to the brand name.
Are there any instances where a brand name is better?
If your health issue is something like seizures, where the drugs carry a narrow therapeutic index (NTI), small differences in dose or blood concentration of a drug can cause profound differences in patient benefit and harm. Stick to the brand if the generic doesn’t work. “Some states have laws that say if you are on anti-epileptic medication and it’s a generic, you have to be alerted if you are changed from one generic drug to another,” explains Dr. White. Other NTI drugs include thyroid hormone medication like levothyroxine (Synthroid), blood thinners like warfarin (Coumadin), seizure medications like carbamazepine (Tegretol XR), and anti-arrhythmic meds like amiodarone (Cordarone), and lithium carbonate (Eskalith), which is commonly used to treat bipolar disorder.
How can I get my doctor to prescribe me a generic?
Once your healthcare provider prescribes a medication, ask if a generic will work as well. Be sure to keep your clinician informed if you feel the medication is ineffective or gives you side effects, and if so, don’t get discouraged. You just may benefit from a different generic. “There is always something new to try,” says Dr. White.
You’ll spend a lot less cash switching to a generic. See if your Rx is available through Blink Health, where you may be able to save even more by having your prescription set up for free home delivery.