Frigging Pharmicist substituted without asking me!

[Ivriniel]

Today I got my prescription for Concerta.

Went to the Pharmacy and picked it up. Was going to talk to the Pharmacist about Concerta vs. generics, but I forgot.

Just checked my pills, and they say Teva Methylphenidate RC.

It’s too late to do anything tonight, but I will be taking it back tomorrow.

I am so annoyed.

ETA: So I’m reading that I should have had my Doctor write “No Substitutions” on the script, but Rick said in his video that this doesn’t make a difference, and that the Pharmacist will go ahead and do it anyways. Which one’s right there?

http://www.addadhdblog.com/generic-concerta-in-canada/#be7ba

I am going to have to go back to my Doctor for another scrip, since the pharmacist filled it with the generic?

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[Anonymous]

It depends on how you pay for your medications. If it’s under insurance, then the default per the insurer may be to substitute the generic if one is available. I’d suggest talking to your pharmacist about this. Ask why exactly this happened and what would be required for you to get the name brand product. Having your doctor write no substitutions might be enough. If the pharmacist has dealt with you and your doctor for a long time, he or she might accept a phone authorization from your doctor this time but want it in writing the next. You might have to pay the difference between the cost of the generic and the name brand. While you’re at it, this might be a good time to ask your pharmacist to make a note in your file requesting that substitutions never be made without consulting you first.

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[Patte Rosebank]

Janssen (the maker of Concerta) has a patient assistance plan which will cover the difference between what is covered by your insurance (including your provincial drug benefit plan) and the actual cost of the Concerta. Ask your pharmacist about it. He or she should have the cards from Janssen. The pharmacist enters your info into the computer, as per the instructions on the Janssen card, and you should be approved immediately.

Health Canada is currently testing Concerta, because it is very obvious that the delivery systems of Concerta and its generics are so different that the generics should not be considered alternatives to real Concerta.

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[Ivriniel]

So I went back to the Pharmacy tonight, and lucked out that the Pharmacist/Owner was on duty. I went in expecting that they wouldn’t take the pills back…After all it’s not like I was returning a box of cereal or something.

But as soon as I explained my concerns, he immediately took the bottle of generic and said he would replace it with Concerta. He said “These pills will have to go in the garbage, but your health is more important.”

He told me that the reason that they substituted the generic is that the College of Pharmacists’ policy is to substitute for generics whenever possible to save the customer money.

While I am on a drug plan, we have to first buy our stuff, and then submit the bills for repayment, so that would not have been a factor in why I was given the generic.

Since the generic was being tossed, I expected to have to pay the full amount for the Concerta, so I was quite pleased that he only charged me the difference between the two. In case anybody is interested, the difference in price between a 2 week supply of Teva 18 mg and Concerta 18 mg is $11.76.

So, in the end, I’m quite satisfied with how it turned out. Just have to remember to have my Doctor write “No substitutions” next time. Hopefully the Concerta will work well enough for me that I’ll remember!

I’m waiting for Saturday to try it out, just in case it makes me drowsy or jittery or nauseous.

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[Patte Rosebank]

I strongly suspect that the College of Pharmacists’ policy on always substituting generics has more to do with the Pharmacies’ getting those kickbacks from the manufacturers of the generics, than with saving the customers money.

Evidently, it’s not enough to just have your doctor HAND-WRITE “no substitutions” on the prescription. You have to point it out to the pharmacist and actually say, “Look! It says, ‘no substitutions’, so please give me the branded drug”.

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[Anonymous]

http://www.caddra.ca/cms4/index.php?option=com_content&view=article&id=212%3Afeedback-on-generic-medication&catid=14%3Aphysicians-main&lang=en

Go to the CADDRA website and write your complaint and it will be forwarded to Health Canada.

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[Anonymous]

Here’s something I wasn’t aware of till a few months ago. If you’re on a generic, do try to stick to the same supplier.

I have been taking lithium for bipolar disorder for several years, with no serious side effects. This summer, I started getting nauseated after taking it. My doctor ordered blood tests, but also suggested we might have to switch to a different medication. I didn’t want to, because lithium and Depakote both worked to stabilize my mood, but lithium also made me more calm and clear-headed. (I think it has an effect on ADHD, which wasn’t diagnosed at the time. But that’s another story.)

I researched everything I could find about lithium toxicity, and found that among all the other variables I was controlling for (exercise, water intake, avoiding alcohol and caffeine), it also turns out that generic lithium can have vary in the amount of active ingredient, composition, etc. One source recommended that patients stick with the same manufacturer for lithium. Sure enough, I had been switched to several different manufacturers around that same time, due to supply chain issues. (After moving from Wal-Mart to Walgreens, I had fewer problems with getting my prescription filled consistently.)

Obviously, I can’t say definitively that switching generic drug manufacturers caused enough variation in lithium blood levels to cause side effects to show up, but the timing suggests that *might* have been the case. It’s something to keep in mind.

I’m better now, blood levels fine.

P.S. I like this site a lot. From a human-computer interaction viewpoint, it’s very friendly. Thanks!

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[Anonymous]

We will be doing a totallybipolar.com site in the future. This project, I hope will be the beginning of what will be a change in the way we perceive mental illness.

As to the issue of “filler” and suppliers- I totally agree. I once had a patient who kept getting side effects from the lactose filler that was in each of the pills they tried.

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[Anonymous]

I just recently had a generic substituted (methylphenidate extended release) for Concerta. Initially I was concerned based on the research I did.

Evidently Watson pharmaceuticals has licensed from Johnson & Johnson the exclusive rights to produce an ‘ultra-generic’ that is identical to Concerta. This product was introduced in Aug 2011 in the US. There hasn’t been any negative complaints from patients to date.

I don’t know if the Watson product is sold in Canada.

Over the next few years many of the brand name stimulants will go generic. From a consumer standpoint it is important that people are aware and ask questions.

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[Anonymous]

That’s interesting news about the ‘new’ version of the generic produced by Watson pharmaceuticals. I’m up here in Canada and haven’t heard about this generic. I use Concerta brand and it is paid for by my employer’s drug plan.

I’m not 100% certain about this but I every new drug has to go through Canada’s drug testing system before it is given the green light for sale up here. That’s EVEN if it has met the US drug guidelines. Strange, eh?

😉

I find it particularly annoying especially since I’m married to an American and I get to hear about all the new products available down your way that we end up waiting forevvvvvvver to get up here and that’s if we get them at all!

BTW, Happy Thanksgiving to you Robert! Enjoy your day tomorrow!

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[Anonymous]

Hi zsazsa,

Thanks for the Thanksgiving greetings, seems like it was long time ago now. I have been in the US (from Ontario) for 11 years now and quite like the American holiday.

As you mentioned all drugs have to go through Health Canada review before it can be used in Canada. It does take a long time.

I have been on the generic for a couple of weeks and seeing a benefit already. Just been put on ADD meds for the first time

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