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December 4, 2012 at 12:36 PMComments: 0 Faves: 0

Are Generic Medications Safe?

By Jeffrey VanWingen M.D. More Blogs by This Author

Medicine has been around longer than recorded history. Take this to treat that, rub this on there to make it go away, drink this and you'll feel better. Somewhere along the line, making medicines became a business.

Today, saying that the pharmaceutical industry is big business is putting it mildly. As consumers of pharmaceutical products, we've arrived at an interesting crossroads. Many drugs are now much less expensive than they once were due to expiring patents. However, while we are not so financially enslaved by the patent, quality issues have arisen over cheap drugs.

Pharmaceutical Heyday

It has been some time since a real blockbuster drug hit the market. Novel and widely used drugs like Prilosec, Claritin, Lipitor and a number of blood pressure medications were staples in the doctor's drug pantry, but that was 10-15 years ago. Now, most of these popular and necessary drugs are generic. This means that the patent life, given by the U.S. Food and Drug Administration (FDA), has expired. 

Ravenous generic drug producers can now produce the same chemicals for distribution. While Prilosec once cost around $100 for one month, generic omeprazole costs about $30 for the same amount. Claritin went from around $70 to $20. Lipitor went from $115 to practically nothing. In fact, one grocer/pharmacy in my home state gives it away for free (Meijer). 

Considering the portion of our population that suffers from gastric reflux, allergies, high cholesterol, and high blood pressure, these generic medications were welcomed by many. Patients saved money and insurance companies saved big money. Some insurance carriers, but not all, passed these cost savings on to their customers, incentivizing them to go generic. Indeed, aside from some niches, it is hard to justify taking a medication that works the same and yet costs scores of dollars more each month.

While science continues to advance at breakneck speeds, the pharmaceutical industry's pipeline of new products seems to be much more restrained. With a few more minor exceptions, blockbuster drugs seem a thing of the past, at least for the forseeable future. While we are still waiting on a cure for the common cold and new remedies are always welcome, the benefits to these expiring patents are quite obvious. And with increasing numbers of eyes watching the cost of healthcare, cheap drugs are welcome. At least one aspect of healthcare is becoming more affordable.

What Are We Getting with Cheap Drugs?

I had always believed that "You get what you pay for." Quality costs more in most circumstances. I would say, however, that patents provide an exception. It's difficult to feel good about a restriction like a patent that keeps costs prohibitive for many. This game keeps insurance costs high and keeps the medication out of the hands of people who would have to buy it outright. 

So, pharmaceutical companies want patients to take their product, paid at a high cost by a third party who's game is keeping their expenditures low in order to increase their profit. Do you see the conundrum here? And despite this confusing state, I am simultaneously sympathetic to all of the research and development that it takes to produce a drug and get it trough the FDA for approval.
Okay, patented drugs cost a lot. Are generic drugs safe, effective, and worth using?  Or are they akin to that dollar store utility tool that my son bought which broke within minutes outside the package - cheap junk?

Reports surfaced this week about a recall on generic Lipitor due to the presence of glass shards. This raises questions about the safety of generic medications. My opinion is that most generics are fine, but I would question your pharmacy about where the generic was produced, being leery of those produced outside the U.S. The manufacturer of the glass tainted Lipitor, for instance, has been cited in the past for quality issues and was further caught lying about its monitoring practices. In sum, provided that the manufacturer is reputable, they are a darn good deal.

The Walmart Business Model

For six years now, Walmart has offered a number of drugs for $4 per month or $10 for three months, and there are now over 300 drugs on this list. As a primary care doctor, I feel that this list is quite comprehensive and covers most prescription I write. Interestingly, most pharmacy/grocery chains followed suit, worried that they would see a mass exodus of their clientele, while stand-alone pharmacy chains such as Walgreens, Rite Aid and CVS did not adopt the $4 business model. 

In analyzing this model, the $4 (and sometimes free) pharmaceuticals are much like the "door busters" of Black Friday. Any profit lost is made up in other ways. For instance, Meijer gives away many antibiotics for free. They know that while an ill person waits for this antibiotic, they are quite likely to stock up on a decongestant, Tylenol, and Kleenex. At Walmart, the person waiting for their $4 blood pressure medication is likely to pick up groceries and other items needed. A 15-30 minute wait in these stores can be costly! The cheap drug is the bait and the wait is the hook. 

I can say from personal experience that they do make customers wait. Like it or not, it's all business, and it's up to us to spend or not spend as we wait for the inexpensive pharmaceuticals.

One caution that I do want to share is the tendency for pharmacies to not "pass charges" on cash purchases of pharmaceuticals. This means that the medications are not registered and put into a system that can be monitored by insurance carriers, etc. The benefit of doing this is that the prescribed drugs go though a program that checks for interactions with other medications being taken. It is a nice system of checks that can prevent problems. If you do pay cash for reduced rate medications, make sure that your pharmacist is checking for interactions with your other medications.

Same Benefit, Fraction of the Cost

Pharmaceutical costs (unlike the cost of most everything else we are buying) are decreasing rapidly with the expiration of patents in major drug classes. Patients will reap the benefits directly with decreased out of pocket cost. Decreased costs on the part of the insurance companies may or may not be passed on to patients via savings on premiums. Provided that the manufacturer is reputable (a U.S. company under strict regulations by the FDA), generic medications provide the same benefit and safety at a fraction of the cost.

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