Pharmacies keep trying to push me on to the Generic.

[Ivriniel]

So I got a new scrip from my Doctor today, and as I was walking across the parking lot, I realized he forgot to write “no substitutions” on it.

My Doctor seems to be about 50/50 on remembering to write that on the scrip, so I made a mental note to tell the Pharmacy tech that was what I wanted.

So I went in, and stood in the big line up. When I finally got to the front, I handed her the prescription and told her that my Doctor forgot to write “no substitutions”. I was flabbergasted when she told me she would have to call my Doctor to confirm that. For one thing, it was 5:30 in the evening, so he wasn’t going to be in his office anymore. For the second point, he wrote the brand name on the scrip. If he had wanted me to have the generic, he would have written that.

I took my scrip back, and told her that I would go elsewhere. She insisted that calling him was no big deal. I told her that it was absurd that she wanted to call the Doctor to ask him if he really meant what he had written. I told her that I had been able to get the brand name before when he forgot to write No Sub, without anyone calling him. In the end, she wrote a note that said I wanted the brand name on the scrip and had me sign it. Then she started going on about how some drug plans didn’t cover the cost of the brand name, and that I would have to pay the extra. Bullpucky. If it was about whether or not my drug plan would cover the cost, she would have started out by asking if I were on a drug plan in the first place. If I hadn’t argued about whether or not she really had to talk to my Doctor before giving me the brand name, then I would have had to wait until at least tomorrow to get the brandname, when she’d be able to talk to my Doctor. This was about making it inconvenient so that I would just roll over and take the generic.

I really felt like this was all just pressure to try and make me take the generic so the pharmacy could get its kickback. Just about everytime I go in with my Concerta prescription, I get some level of pressure to take the generic instead. Even if my Doctor remembers to write “No Sub” then they feel the need to tell me that there is a cheaper generic, and maybe I should talk to my Doctor about it.

It’s happened to me at different pharmacies, and I am fed up. I am going to write to the College of Pharmacies and the Ministry of Health about this.

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[Anonymous]

i got a generic (teva) when i gave the pharmacist my first ever script for concerta, 11 days ago. it gave me wicked headaches every evening- ‘lie on the couch in a darkened room and wish i would pass out just to make it stop’ ones.

now i’m wondering if:

a) it was down to the methylphenidate itself, or just that specific generic brand formulation

b) if i can ask for another specific generic or brand name, next time i refill it (i have to wait to do that- and i aint taking anymore headache pills meanwhile) and whether i’m likely to get my way

c) if i wanna go through the whole hassle of faffing about trying different brands- if i’m gonna quite possibly end up with another flipping headache and a pile of wasted pills each time i do that

d) if i really wanna be on a drug formulation that can so easily be changed without my consent, if the change makes my brain hurt intensely…. at least with strattera there isn’t a generic, and with the other generics i take i feel fine regardless of manufacturer.

……do generics make a difference when it comes to side effects- or is it just about how well they work for some people?

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[Ivriniel]

If your meds are giving you an adverse effect, you should really see your Doctor before you refill.

And if you get dispensed Teva after your prescription said Concerta, don’t be shy about going back to the Pharmacy to get what you wanted. The first time I filled my Concerta Prescription, my Doctor (who just graduated in July) was unaware that Pharmacists would substitute without speaking to the patient, so he didn’t write No Sub, and it was only after I got home, that I realized that they hadn’t given me Concerta.

I took my prescription back and spoke to the Pharmacist owner, who took back the Teva, and gave me Concerta. Despite the fact he was going to have to throw out the Teva, he only charged me the difference between Teva and Concerta.

The Pharmacist told me that it is the position of the College of Pharmacists in Ontario to dispense the generic whenever there is one available, in order to save the public money. That’s all well and good, but it seems to me that if that is the motivation, they should talk to patients before making substitutions.

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[Anonymous]

With Concerta, the generic is NOT NOT NOT a substutute. In the site somewhere, they actually say that it takes like 3 weeks to make a Concerta pill. They laser drill a hole in one end for the release mech. The other ones are just Rittilan, in a pill that mimics the release over time. I just went through it, trying to find a working replacement. Nothing is like Concerta.

Make sure you Doc puts NO SUB on your script.

Dave

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[Patte Rosebank]

Generic “Concerta” is so completely NOT a substitute for real Concerta, that Health Canada is currently studying the matter in detail.

As Concerta’s patented delivery system is precisely what makes it Concerta, it is very likely that Health Canada will soon issue an official ruling that there is NO substitute for real Concerta.

Rick explains this in detail, here in Part 4 of his series on Generics: http://totallyadd.com/generics-part-4.

There is a serious problem with generic versions of drugs for treating mental conditions. The guidelines for generics allow a concentration of from 10% less to 10% more than the concentration in the branded version. That’s a range of 20%, and it’s a HUGE range, when you’re treating an organ as sensitive as the brain.

It’s also dangerous, particularly if your pharmacy suddenly switches from a generic brand that’s 10% less, to another that’s 10% more. That’s a huge increase in dosage, and you won’t even know it’s happened!

And if your pharmacy switches from a generic brand that’s 10% more to one that’s 10% less, you’ll wonder why your usual dose suddenly isn’t working. Pharmacies switch generic brands all the time, and they don’t have to inform patients that they’ve done it.

Another issue is that generics use different filler materials than branded versions do. Generic forms of Ritalin contain milk-based ingredients. Many patients have had bad reactions to generic Ritalin, but respond very well to real Ritalin.

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[Patte Rosebank]

One more thing: Janssen (the maker of Concerta) has a Patient Assistance Plan, to cover the portion of the cost that your insurance won’t.

Just ask your pharmacist about it. He or she will have a card from Janssen, with the details. The pharmacist enters your information into the computer, submits it, and in just a couple of minutes, you’ll be approved.

I’m on the Trillium Drug Plan, which only pays for generics. With the help of the Janssen Plan, my Concerta doesn’t cost me anything.

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[Anonymous]

oh really…. hmmm! i’m gonna look that up! thanks!

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[CJ]

OK I work in a pharmacy and I just have to stand up for the employees here. First of all the store does not make more money for dispensing the generic, the dispensing fee is the same for any drug. By law the pharmacy is required to dispense the least expensive brand available. Government and most other drug plans will only cover the generic brand because it is cheaper for them and will only pay for the brand name if the doctor specifies ‘no sub’ in writing. Some plans will not cover the name brand under any circumstances. In all cases it would be so much easier to give the customer what they want it’s governments and insurance companies that complicate things.

That said, I totally agree that there is no real substitute for Concerta. I’ve used both generic and brand name and the difference is huge. I’ve heard the same from pretty much everyone who has used it or has a child taking it. We actually dispense very little of the generic brand which is fine with me.

My doctor gave me one of the cards from Janssen and it covers what my drug plan doesn’t. You have to get if from your doctor though the company does not supply them to drugstores. Even if you don’t have a drug plan it will pay the difference between the brand name and generic which is a little help, that stuff is expensive.

Just to clarify, this is in Canada. I don’t know what the rules are in other countries.

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[Anonymous]

I have to agree with CJ on this. The generic shuffle has more to do with your insurance and the drug companies they align with than the pharmacy or even the doctor. I work for a GYN office and I cannot tell you the hours I have spent on the phone dealing with these ‘big box’ mail order pharmacies who substitute meds without telling the patient or even flat out LIE and tell us that the patient CHOSE the generic. I now do follow up calls just to check and see if the patient did in fact want the generic. It’s insane. Unfortunately, our meds are expensive and they will always try and push the generic on you. The programs that the drug companies provide now are great in helping financially when your insurance plan won’t cover the cost of brand. I’m not sure how things work in Canada, but I have also had to have my meds prior authorized by my doc, and I do it here at my job all the time. They ask a few questions, to verify that you in fact NEED the brand name (ridiculous, I know) and typically with authorize the med for up to a year.

The irony is that the best advice I can give is the achilles heel for us. Make sure you double check the Rx before you leave the doc’s office. Docs get so used to writing script, sometimes they are on autopilot. I encourage our patients at checkout to read their scripts to make sure they are correct before they leave. Checking or signing DAW or Do not sub. takes a second, and sitting in the lobby for a few minutes while you wait for the doc to fix the Rx beats battling ANYONE for your meds

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[Ivriniel]

CJ: I don’t know where you are, but in Ontario, generic drug companies pay “roll backs” to Pharmacists when they substitute the generic for brand name medications. Recently when the Provincial Government tried to end the practise the Pharmacists put up a hue and cry. Rick did a video about it.

Steffie101: FOr me, the “generic shuffle” has nothing to do with my insurance, since I pay out of pocket and then get reimbursed. Also, telling someone with ADHD to make sure they check their prescription before they leave the Doctor’s office is not a winning strategy.

Anyways, the reason I am pulling this Zombie thread up from the depths of the board is that t for the first time since I moved to a new city, I went to fill my Concerta prescription today.

It was great. Noone tried to push the generic on me, and the Pharmacist even applied the Concerta Copay card without me even having to ask about it. Best service I’ve had in a pharmacy since I started taking Concerta.

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[billd]

Makes me glad I live here………. no hassle. They can’t substitute unless it says it’s ok to substitute (for all the reasons given above about the differences)

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[munchkin]

I’m in the US – I just started generic Concerta today, no problem so far… It was still going to cost me $2 a pill (per my insurance company) whether I took brand or generic. I decided to try the generic for a few reasons:

1. I have never ever had a problem with a generic vs. brand name medication – so, I’m not too worried (although, I will definitely switch back if it seems inferior)

2. The biggest deal about Concerta is the delivery system – the pill with the lazer drilled thingy. The pharmacist said the generic was being made by Alza, which is the same factory as the brand name. So, I felt comfortable that it was going to be exactly the same.

3. The pharmacy is planning to phase out the brand name, and only have generic available – so I thought I would just go ahead and switch since it seems to be inevitable. (I suppose I can go shopping around – maybe another pharmacy will keep carrying the brand name…

So – I’m curious to see if I will have any problem since other people are saying there’s a major difference… I wonder if the generic in Canada is different than the one in the US… I have no idea.

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[Anonymous]

Real Ritalin and the real Concerta uses lactose the same as the generic ritalin and the generic concerta.

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[caper]

I’m taking APO MPH-SR (generic Ritalin SR). It uses a methylcellulose binder to effect the delayed release, and I don’t recall seeing anything about lactose on the product monograph. Nice & cheap too: 25c/pill for 20mg. 54mg concerta was costing me $4/pill, was giving me side-effects (tightness in the chest) in the afternoon when the levels peak, and would only last ~11-12hrs. Now that I’m taking 2 Ritalin SR per day (1 when I wake up in the am, and one after lunch) I have no side-effects of overdosing and it lasts ~14-15hrs.

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[Anonymous]

Without question, there are enormous clinical differences for some people. Unfortunately, Canada and the US are taking two opposing positions on the importance of testing multiphasic drugs to determine the ACTUAL difference between proprietary and generic drug formulations. Here is a link to a very recent (abstract of an) article on the issue:

http://www.ncbi.nlm.nih.gov/pubmed/21849209

“It is suggested that without applying an additional metric such as partial AUC, some multiphasic MR drug products might falsely be assumed to be therapeutically equivalent and unexpected clinical effects may occur.” I’m a clinician and have had patients deteriorate to pre-treatment levels when generic versions have been substituted.

(Here in Ontario) if your doctor forgets to add “no subs” on the script, have the pharmacy call to clarify. Also, if your doctor uses an electronic medical record (EMR), they can preset the system so that the ‘no subs’ indication is automated on the prescription at each renewal. At the end of the day, for the things we’re not good at…. we need to delegate to others.

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