Overpaying for generic medicine

[blankcheck]

As for the increase in kidney disease, I'm not sure but I'm willing to bet it is due to the rapidly rising rate of diabetes which, in turn, is due to the obesity epidemic. People are eating themselves to death in this country and nobody has a clue what to do about it.

Getting a bit sidetracked, but have to say something here. We pretty much know what to do about it (eat less, exercise, maintain a routine of sleep and moderation of stressful stuff for our bodies and minds) but the implementation is a whole 'nother problem. That's where physicians come in, and frankly, I wonder much like you what we can do about it.


...as for the whole "doctors use pills too much," It's that old joke:

-you're sick, here eat this root.
-we found what's in the root, and concentrated it. drink this extract.
-we have a modified version and we're trying to reduce side effects. take this pill
-this pill doesn't agree with the way your body processes things. Take this herbal supplement.
-this supplement is just a knockoff version of the whole thing. Here, eat this root...

If we don't value this type of investigation, then by all means, let me know on the whole and psychiatrists can just concentrate on the perfect talk therapy for schizophrenia instead of relying on antipsychotics too.

[disneysteve]

Getting a bit sidetracked, but have to say something here. We pretty much know what to do about it (eat less, exercise, maintain a routine of sleep and moderation of stressful stuff for our bodies and minds) but the implementation is a whole 'nother problem. That's where physicians come in, and frankly, I wonder much like you what we can do about it.

For sure, I know exactly what to do to treat and prevent obesity. The problem is nobody wants to listen.

[Scanner]

RedThunder/DisneySteve

I am not trying to "blame" anyone for the pharmaceutical expenditure/consumption of our nation. . .it's not family doctor's fault or psychiatrist's faults, etc. . .I am saying that I think it's a cultural problem. I hope I didn't come across as finger pointing.

I am merely pointing that out that everyone doesn't ask any questions (except for me) as to how and why all of the sudden drugs are available at $4.00.

What if a drug dealer said to you, "I can get you your pot now at $4/bag? So don't worry about that daily reefer getting too expensive."

Aren't you the least bit suspicious?

Again, I am not a conspiracy theorist but there's something rotten in Denmark as they say.

That's why I made the reference of the world per capita consumption of oil in comparison with our per capita consumption of pharmaceuticals. I very, very much beleive that 99% of doctors (real ones, not like me) do their best to limit medications. That's not just a platitude offered to DS and blankcheck; I sincerely beleive it working along side with primary care (they are in my office) for 4 years now.

Despite everyone's best efforts, here we are.

(Clarification: what I meant by "lessor profession" was I meant "less politically powerful", not lessor in any other way. I would say chiropractors are probably the most politically powerful drugless profession out there but our voice is a tiny squeak in the huge chorus of pharmaceutical and insurance symphony. We are simply drowned out. Nothing against naturopaths or acupuncturists)

1 in 3 ads during prime time TV are for direct market pharmaceutical ads. 1 in 3!!! That has a cultural effect.

So, okay, enough chat about it - like DS says, there is only so much you can talk before people will change.

I say you have to hit people where it hurts - their pocketbook.

Tax the following:

1. Liquor
2. Cigarettes
3. Sugary drinks and foods
4. Attach a 10% health premium on every 10% over a normal BMI they are.

You would see lifestyle diseases plummet. And then instead of 5 medications as DS points out, you would maybe see 1 and not "lifestyle drugs."

The solution will have to be societal as I don't think the medical profession, any profession, has the ability to enact a public health change.

[disneysteve]

I am merely pointing that out that everyone doesn't ask any questions (except for me) as to how and why all of the sudden drugs are available at $4.00.

Scanner, I don't think there is anything suspicious here at all. It isn't that the wholesale cost of the drugs suddenly plummeted. The price has been dirt cheap for a long time and pharmacies were making a bundle on the huge mark-up in retail price. WalMart came along and decided that they could sell them for $4 and still make a profit, plus draw a lot of customers into their stores who would likely buy other things. Personally, I think it is brilliant marketing.

I gave an example of the mark-up earlier. Pharmacies would price generics to make them seem like a good deal vs. the brand but make a fortune in the process. If the generic is $.05/pill and the brand is $1.00/pill but you sell the brand for $1.25 and the generic for $.75, you make a lot more money on the generic.

[Scanner]

Okay, I am just paranoid, I guess.

There's nothing rotten in Denmark. Walmart just saved the day. Every generic regardless of difficulty of synthesis, costs $4. To me, it would make sense to me that one generic may cost $3 and another generic would cost $11. . .but okay, every generic drug costs $4.

But that's why the forum keeps me around - because I am the Forum Cuke and advocated things like buying silver in 2006.

And I appreciate the party-line analyses more than you know because I think so non-traditionally about subjects. . .I do think I am lost sometimes.

[disneysteve]

Every generic regardless of difficulty of synthesis, costs $4. To me, it would make sense to me that one generic may cost $3 and another generic would cost $11. . .but okay, every generic drug costs $4.

Sorry, I misunderstood the point you were trying to make. Certainly, I think you're right about the pricing thing. Not every drug costs the same amount. I'm sure some cost more, some cost less and WalMart just chose the $4 price point as a marketing tool, and a darned good one IMO.

WalMart is a HUGE company. I've read some reports and seen some stuff on TV that discusses their sales volume and it is phenomenal. They have a ton of influence on their supply chain. I'm sure they are able to buy meds in such outrageous quantities that the manufacturers give them a substantial volume discount. I've spoken to my pharmacist friend who has told me that several of the meds on the WalMart plan cost him more than $4 to buy wholesale, but he can't buy the kind of quantity they buy so he doesn't get the same deal. I'm also willing to bet there are meds on the $4 list that WalMart sells at a loss just to get people into the store, but having loss leaders is nothing new. Supermarkets have been doing it for years.

[nmboone]

Frugalfish- I work at Walgreens pharmacy and there is something there called a Prescription Savings Club. It helps people save with pets medication as well as people's. Your local Walgreens pharmacy would be more than happy to give you a quote for the PSC price. The cost for the PSC is $20 per individual per year, or $35 for a family. I know firsthand that it saves people A LOT of money!

[mom-from-missouri]

Disney::


Quote:
Originally Posted by pinkpink
"The problem that I have is that my doctor thinks that generic brands are not as good as the name brand for the medication that I take and recommends that I stay with the name brand even though there is a generic brand available.

Just because he recommends it doesn't mean you have to do it. Tell him you can't afford the brand and ask that he write it to allow for generic substitution."

I once had a doctor who REFUSED to sign for a generic. He only signed on the side for brand name. Because of the insurance I had at the time, the drugs as a result were not covered if they were brand.

I had to go through hoops to change doctors on the HMO. It took me 3-4 months to get a different doctor.

[disneysteve]

I once had a doctor who REFUSED to sign for a generic. He only signed on the side for brand name. Because of the insurance I had at the time, the drugs as a result were not covered if they were brand.

That's unacceptable IMO and certainly warrants changing doctors. We doctors need to be aware that we can't practice ivory-tower medicine because neither we nor our patients live in ivory towers. Sure, there are times when I think a brand product is better in some way, but if my patient can't afford it, what good is it? I have lots of patients taking generic pravastatin for their high cholesterol because it is $4/month. I don't think pravastatin is nearly as good as Lipitor and definitely not as good as Crestor, but those are both very expensive and many of my patients simply can't afford them, so I prescribe pravastatin for those patients. It isn't the best choice, but it is the affordable choice.

[Goldy1]

It's a shame we have to go shopping around tons of places for healthcare and meds. I'd rather spend my time living my life.

On the obesity thing. Granted, I am one of those naturally thin types so I feel judgmental talking about obese people who eat a lot.

However, I know a women who had gastric bypass to try and cure her obesity (another trend) and she came to my barbeque a few weeks ago and ate half a steak and a full piece of chocolate cake. I ate a salad with a chicken breast on it b/c I don't eat red meat(not saying you can't be healthy and eat red meat etc) but this is the problem. She has always ate a lot of unhealthy stuff I won't and I am thin. I did eat cake too, (again feeling judgemental) but no one wants to change. Let the surgery or the pill or the fad diet do it. It won't work. Moderation. EAt less, move more. period.

[nmboone]

Unfortunately I've never been able to use Walmart's $4 generics. Every time I get a script the generic has been really expensive too.

[disneysteve]

Unfortunately I've never been able to use Walmart's $4 generics. Every time I get a script the generic has been really expensive too.

Sometimes, there isn't a really cheap option. In those cases, the best thing to do is call around and get price quotes from multiple pharmacies. Also, as mentioned, find out if there are any discounts available on the brand version. Sometimes with the discount, the brand is as cheap or cheaper than the generic.

The other thing you should always do when cost is an issue is ask your doctor if there is a cheaper option.

[irmanator]

disney steve:

you said:
That said, there are certain drugs that have a very narrow therapeutic dose and sticking with brand is a good idea. These include Coumadin, Theophylline and Thyroid meds among others.

I am prescribed synthroid and get the generic of levothyroxin..... Is this a good generic ???

[disneysteve]

you said:
That said, there are certain drugs that have a very narrow therapeutic dose and sticking with brand is a good idea. These include Coumadin, Theophylline and Thyroid meds among others.

I am prescribed synthroid and get the generic of levothyroxin..... Is this a good generic ???

It depends on who you ask and depends on the individual patient. Thyroid meds are kind of different than other meds as they are replacing a natural hormone that is lacking. The level of replacement is important. That's not that true for other meds like an antibiotic for example. Whether the penicillin pill you take contains 500mg or 490mg or 510mg really doesn't matter. It will do the job just fine.

Now look at Synthroid. It comes in 25mcg, 50, 75, 100, 112, 125, 150 and more. The reason for so many strengths is that it can require a fairly fine adjustment to find the dose that keeps your blood level where it needs to be. So if you've been taking the brand name 100mcg pill and you switch to the generic and you get a batch that only actually has 92mcg, that might throw off your blood level enough to be an issue. The next time you get a refill, though, the generic might be 106mcg. That variation, in some patients who are very sensitive, can cause problems.

Personally, I almost always prescribe generic because I don't think it matters for the vast majority of patients. That said, some of the endocrinologists I refer to always prescribe brand name only. As I've said, though, I work with a poor population and for most of my patients, the brand name isn't affordable.

So to answer your question, the generic is fine as long as you are doing well with it. If, however, your doctor has had trouble regulating your blood level, the variability in the generic could be part of the problem.

[irmanator]

steve thanks for answering. I guess my levels are fine as she only changed it once when i gained some weight and back to original when i lost the weight. I have been on it for 14 yrs