I blame Romney.

Kerfluffle!!!



Maybe mom isn't as paranoid as I thought.

So glad I'm in hospital pharmacy instead of retail pharmacy now. Retail pharmacies are going to be dealing with weeks of patients insisting on brand named everything (99% which isn't stocked in pharmacies anymore)

Translation: The big pharmacy companies want to scare you into spending more, for the name brand product

well, let's see--I"m very sick and can't afford the $85 pill from the big drug company. What to do?

OhLuverly: So glad I'm in hospital pharmacy instead of retail pharmacy now. Retail pharmacies are going to be dealing with weeks of patients insisting on brand named everything (99% which isn't stocked in pharmacies anymore)

Price according to supply and demand. Profit!

If I hear "I can only take brand-name Percocet, I'm allergic to all the generics" one more time, I swear to god i will kick the speaker right in the nuts, or get my foot stuck trying.

Eh, there was bound to be one to slip through the cracks out of all the generic medications out there. I wouldn't get your panties in a bunch over it.

OhLuverly: So glad I'm in hospital pharmacy instead of retail pharmacy now. Retail pharmacies are going to be dealing with weeks of patients insisting on brand named everything (99% which isn't stocked in pharmacies anymore)

Tech, PharmD, or student?

My wife used to work for Teva as a chem e making birth control and she assured me it was the exact same product. She says the biggest issue with generics is when it's a time release drug. The time release part is the hardest part to pin down and can be working just fine and then fail for no readily apparent reason. She hated working for Teva and remarked daily about what a poorly run company they are. Jim Cramer had Teva as a buy stock sometime last year and they've lost like 20% of their value since then. She was elated to hear about this because she hates them so much. Friday was her last day there. She squealed with delight at the bad news.

justtray: Some company cheated. They had a different product packaged and labelled incorrectly. That's why it's pulled. When you by Advil, you are getting Ibuprofen. Advil is the Brand, Ibuprofen is the generic. When you buy Joe's offbrand Ibuprofen, you are getting the same thing as Advil. In this particular case, they were not, and thus they pulled the product from the shelf correctly.

Thank you for correctly showing that subby must be related to Jenny McCarthy.

i buy drugs at harbor frieght

justtray: aacharya: NewportBarGuy: This could very well cost all of us tens of billions of dollars per year. Seriously, this is a big thing for them to say. They will spin the hell out of this because the generic market is so goddamn large. The move to switch and save had been the MO for at least a decade.

I'd keep an eye on this case if you are concerned about the health care industry and its inherent cost to all of us.

Hopefully, it is a one off and shows that the FDA can find those drugs that are not equivalent to the brand. Frankly, I'm surprised it took this long and expect a dramatic increase to the testing of and discrepancies found in generics.

Man, take the tinfoil off. This is more of a one-off than another issue about generics being bad. Simply put, FDA allowed a waiver based on sound science and logic, and it didn't turn out well, because the 150 mg was not representative of the 300 mg.

But go ahead and make up theories. It's fun to read.

This.

Not sure why it would "cost us tens of billions of dollars." That doesn't even make sense in any capacity. Thankfully you went to the effort of not explaining yourself other than to be very concerned.

Some company cheated. They had a different product packaged and labelled incorrectly. That's why it's pulled. When you by Advil, you are getting Ibuprofen. Advil is the Brand, Ibuprofen is the generic. When you buy Joe's offbrand Ibuprofen, you are getting the same thing as Advil. In this particular case, they were not, and thus they pulled the product from the shelf correctly.

Now, this doesn't mean that there aren't other drugs incorrectly labelled, but it also doesn't give us any evidence to assume there is.

Perhaps I misread Newport's comment but I agreed with him.

It could cost us tens of billions of dollars because this one single case will be trumpeted by the makers of name brand drugs as a shining beacon of why name brand drugs are better. And a portion of the country will be swayed, for instance everyone on Wellbutrin, right? Put another way - this example coupled with the stupidity of the country will indeed cost us billions. And the name brand drug makers will indeed spin the farking hell out of this.

I think you both need to clean the sand out of your vaginas, his comment did not read as an anti-generic drugs post.

Further, you cannot reply and mock him for misinformation and then fill your post with bullshiat. Advil is indeed just the brand name of ibuprofen. When you take ibuprofen, you want it all right away because your head hurts. So 150mgs of ibuprofen is 150mgs of ibuprofen, whether you coat it with sugar or not (mmmm sugar coated Advil). Wellbutrin is not designed to be delivered all at once immediately. It is supposed to be delivered slowly. The name Wellbutrin makers went through lots of trials and figured out a formulation that does it quite well. Then the generics came along and in trying to copy it, sure they made the same chemical but this time it is released all at once, so you get super high to start and then you have no Wellbutrin later.

You would have known all of this had you... read the farking article, dipshiat.

Is the LA Times even a major newspaper anymore? Their writing sucks.

/LA-area resident

One of my colleagues is taking Synthroid, and refuses the generic because the same kinds of "rumors" from users are out there concerning its effectiveness. Our insurance won't pay for name-brand Synthroid, so he pays out of pocket for it. I wonder whether the FDA will look into that, too.

Also, regarding birth control, I don't even remember which option this was or whether it was a Teva drug, it was so long ago, but at one point the gynecologist gave me a long explanation of why the generic version of one drug was not actually the same as the more expensive name brand. I figure the doctor ought to know.

OhLuverly: So glad I'm in hospital pharmacy instead of retail pharmacy now. Retail pharmacies are going to be dealing with weeks of patients insisting on brand named everything (99% which isn't stocked in pharmacies anymore)

That would require consumers to have any clue about their own health care. If it isn't delivered by the TV via inscrutable spots with soft piano music or blooming grass, they won't ask for it. Situation won't be any different than normal, people will continue asking for brand names, receiving generics from the counter, and go away happy and clueless.

I came to complain that this is not a "generic drugs are worthless" problem but a "company is lying about their generic equivalent" problem. But I see that's been covered pretty thoroughly.

Seriously, this is chemistry. A true generic equivalent has chemically identical active ingredients. It's not terribly difficult to analyze the drug in question and determine whether it really is what Teva claims. The story is that it took five goddamn years for the FDA to take action.

jtown: Seriously, this is chemistry. A true generic equivalent has chemically identical active ingredients. It's not terribly difficult to analyze the drug in question and determine whether it really is what Teva claims. The story is that it took five goddamn years for the FDA to take action.

Read the article dude.

office_despot: One of my colleagues is taking Synthroid, and refuses the generic because the same kinds of "rumors" from users are out there concerning its effectiveness. Our insurance won't pay for name-brand Synthroid, so he pays out of pocket for it. I wonder whether the FDA will look into that, too.

Also, regarding birth control, I don't even remember which option this was or whether it was a Teva drug, it was so long ago, but at one point the gynecologist gave me a long explanation of why the generic version of one drug was not actually the same as the more expensive name brand. I figure the doctor ought to know.

I hate rambling doctors. 90% of the time you can get a more concise answer via webmd or at least a google search; communication should be a required class in med school given that half of doctoring is actually asking or lecturing.

anyone who's ever taken name-brand wellbutrin 300 xls and then was switched to generics can tell you this, and we've been saying it for years and years and years. but try to tell a doctor or pharmacist that and you'll just get a huge lecture. professionals always know better than psychiatric patients.

i've heard the same thing about synthroid, but i've never taken it.

also, People's Pharmacy

jtown: A true generic equivalent has chemically identical active ingredients.

This is true, but how the drug is packaged and combined with other inert ingredients can also make a difference in how it works.

office_despot: One of my colleagues is taking Synthroid, and refuses the generic because the same kinds of "rumors" from users are out there concerning its effectiveness. Our insurance won't pay for name-brand Synthroid, so he pays out of pocket for it. I wonder whether the FDA will look into that, too.

Also, regarding birth control, I don't even remember which option this was or whether it was a Teva drug, it was so long ago, but at one point the gynecologist gave me a long explanation of why the generic version of one drug was not actually the same as the more expensive name brand. I figure the doctor ought to know.

Actually, that's true about levothyroxine, the drug in Synthroid. There are several generics out there, and switching between them is hugely problematic because the drug is measured in micrograms and there can actually be a difference in effective medicine between the different generics vs the name brand. Also, different people have different reactions to the non-active ingredients used in the different versions that can affect uptake.

That said, once you're on a generic that you tolerate well and you get your levels properly checked you should be fine continuing on that brand of generic. The problem comes in if you have to switch pharmacies and they carry the generics manufactured by a different company that might contain a slightly different dose or different inactive ingredients.

/at least that's what the endocrinologists tell me
//including the one I was dating last year
///total thyroidectomies are superfun!

I stopped reading at "five-year kerfuffle".

/kerfuffle

There's a widespread belief that big drug companies that sell expensive drugs like Prozac, Percocet, and Valium are somehow evil and conniving, but somehow the companies who make and sell the generics get a pass.

Please take a moment to read about generic drugs. There are many good sources out there including the FDA and even wikipedia's section is solid. Generic drugs have been marketed as "the same" and "just as good as" trade name drugs, but the phrase I want you to look for is "The FDA requires the bioequivalence of the generic product to be at least 80% of that of the innovator product."

In reality, the cheapest and easiest way to make a generic drug is to start with 20% less of the active ingredient.

That phrase is why people who regularly take Percocet and Valium tend to ask for the "trade name" version of the drug. They frequently are getting only ~20% of the effect they have grown to expect. You can't sense this in an antibiotic or a anti-hypertensive, but you can in "nerve pills" and pain pills.

As an anesthesiologist in training, I used to administer a muscle relaxant called Norcuron whose active ingredient was vercuronium. I would give a milligram or two intravenously, and by measuring the patient's response to the drug by electrical stimulation would know when the drug wore off. Then we switched to generic Vercurionum. It quickly became apparent that we needed to use a lot a more of the generic stuff than than the name brand stuff. That got me interested in what the term "generic" meant medically. It turned out to be a legal definition.

Personally, when it's me or my family, and it's a serious problem, I try to get the name brand version of the drug. Remember, when something sounds too good to be true, it sometimes is.

/loves me the giant generic jug of ibuprofen, but sometimes need to take three.

xmasbaby: In reality, the cheapest and easiest way to make a generic drug is to start with 20% less of the active ingredient.

That phrase is why people who regularly take Percocet and Valium tend to ask for the "trade name" version of the drug. They frequently are getting only ~20% of the effect they have grown to expect.

You may have been told there would be no math but you're gonna want to re-look at your post.

xmasbaby: As an anesthesiologist in training

Oh shiat, you're REALLY gonna need to look back at your math dude.

Here in Cambodia Viagra and all its fellow boner pills is a big seller. In convenience stores the assorted brands are offered in a handy dispenser on the counter, about where the jerky is in an American 7-11. The prices for a 4-pill box are all over the map with brand-name "Viagra" going for an absurd $12 and the Indian knockoff "Kamagra" costing $3. Indeed the world's most prudish and overpopulated nation appears to have a massive presence in the trail mix market (which makes sense for a number of cynical reasons that suggest themselves). There is of course no noticeable difference in efficacy, so the American brands are quite against the wall in the price war. I especially like Kamagra's fast-acting 1-dose packs of flavored jellies which have you ready for action by the time you finish your toast and coffee.

Yes, I know I should feel guilty for not supporting American innovation. Generous profits for Pfizer means more for research and greater discoveries to come, but what more can they give us? A horny pill for the ladies may sound neat at first blush, but unless some mechanism for discrimination be built into it you're as likely to find your love interest shagging the neighbor or the dog or a wooden toilet paper holder rather than you. There are some doors progress should leave unopened.

xmasbaby: There's a widespread belief that big drug companies that sell expensive drugs like Prozac, Percocet, and Valium are somehow evil and conniving, but somehow the companies who make and sell the generics get a pass.

Please take a moment to read about generic drugs. There are many good sources out there including the FDA and even wikipedia's section is solid. Generic drugs have been marketed as "the same" and "just as good as" trade name drugs, but the phrase I want you to look for is "The FDA requires the bioequivalence of the generic product to be at least 80% of that of the innovator product."

In reality, the cheapest and easiest way to make a generic drug is to start with 20% less of the active ingredient.

That phrase is why people who regularly take Percocet and Valium tend to ask for the "trade name" version of the drug. They frequently are getting only ~20% of the effect they have grown to expect. You can't sense this in an antibiotic or a anti-hypertensive, but you can in "nerve pills" and pain pills.

As an anesthesiologist in training, I used to administer a muscle relaxant called Norcuron whose active ingredient was vercuronium. I would give a milligram or two intravenously, and by measuring the patient's response to the drug by electrical stimulation would know when the drug wore off. Then we switched to generic Vercurionum. It quickly became apparent that we needed to use a lot a more of the generic stuff than than the name brand stuff. That got me interested in what the term "generic" meant medically. It turned out to be a legal definition.

Personally, when it's me or my family, and it's a serious problem, I try to get the name brand version of the drug. Remember, when something sounds too good to be true, it sometimes is.

/loves me the giant generic jug of ibuprofen, but sometimes need to take three.

The hell are you on about?

FIRST of all, "Brand name" percocet is contracted out to Mallinckrodt, who also makes the generic. SAME GODDAMNED PILL!

SECOND, the "80%" thing means that each BATCH of drug contains +/- 20% of the active ingredient as advertised, something name brand drugs must also adhere to.

THIRD, I pray to FSM I never get your stupid ass as an anesthaesiologist.

In case TFA isn't clear, the problem was specifically with the extended-release mechanism. This has been a known problem since Wellbutrin XL came off patent.

In most extended-release formulations, the rate at which drug is released is remarkably irrelevant. But since buproprion is such a godawful drug, you need to slow down absorption as much as possible due to GI upset and suicidal thoughts from too much of it in your system at once.

Basically, if you're on buproprion (Or for that matter venlafaxine/Effexor), tell your shrink to switch you to something else. I've never had anyone come in to my pharmacy and say "Wow, this Wellbutrin has really changed my life for the better!"; it's always to the contrary.

Also, there is the unspoken "rule" in psych meds of sticking to one manufacturer once you're stable.

/SO freaking glad I'm in nuclear pharma now so I don't have to deal with this crap.

xmasbaby:
As an anesthesiologist in training, I used to administer a muscle relaxant called Norcuron whose active ingredient was vercuronium. I would give a milligram or two intravenously, and by ....

Interesting. What's your handicap?

lennavan: xmasbaby: In reality, the cheapest and easiest way to make a generic drug is to start with 20% less of the active ingredient.

That phrase is why people who regularly take Percocet and Valium tend to ask for the "trade name" version of the drug. They frequently are getting only ~20% of the effect they have grown to expect.

You may have been told there would be no math but you're gonna want to re-look at your post.

xmasbaby: As an anesthesiologist in training

Oh shiat, you're REALLY gonna need to look back at your math dude.

Yeah, that was a typo. I meant to say, ~20% less. xmasbaby regrets the error.

They say preview is your friend, I say, so is coffee.

BigLuca: xmasbaby:
As an anesthesiologist in training, I used to administer a muscle relaxant called Norcuron whose active ingredient was vercuronium. I would give a milligram or two intravenously, and by ....

Interesting. What's your handicap?

I'm farsighted and and terrified of trees :)

I never picked up golfing, but my friends love it and I live in a place with great golf courses. I also live in a place with great mountain biking and and amazing surf.

Well I noticed this:

Modafinil had a brand name Provigil. Then came the all-brand-new Nuvigil (armodafinil) from the same company, which is also modafinil. Sort of.

Modafinil has both left- and right-handed enantiomer versions of its molecules. Modafinil/Provigil is racemic- an equal mix of both. Of those, Nuvigil (armodafinil) is only the (−)-(R)-enantiomer of it.

So modafinil has always been 50% armodafinil... and 50% the left-handed version, which has no specific name other than modafinil. The armodafinil enantiomer is supposed to be substantially more active.

Just noting, the importance of the ratio of left- and right-handed enantiomers MIGHT be important, yet disregarded by generic mfgs, and that could account for "differences".

Of course, the original patent holder is not inclined to "help" with such issues. They hold the secrets pretty tightly and would be delighted if the generic version couldn't deliver the same results.

Morgellons:
Basically, if you're on buproprion (Or for that matter venlafaxine/Effexor), tell your shrink to switch you to something else. I've never had anyone come in to my pharmacy and say "Wow, this Wellbutrin has really changed my life for the better!"; it's always to the contrary.


that's an incredibly stupid/ignorant thing to say.

i'm happy to say that wellbutrin has really changed my life for the better. wow.

seriously, it's the best thing ever. SSRIs and SSNRIs were awful. awwwfulllll. i was down for the one MAObI i tried, but then i tried wellbutrin, and yeah, that hit the sweet spot. and it does wonders for huge numbers of other people, too.

and sticking to one manufacturer is a cute fairy tale that people in whatever sphere of PharmaHell you're in must believe in. pharmacies change generic brands all the time.

I am part of an online mental health community and we had a number of first hand accounts of the issues with the generic Welburtin. I want to say we've been talking about this problem for about 6 years or so. There are also issues with generic seizure medication and thyroid meds, just to name a couple. My PCP insists that I take Synthroid and not the generic levothyroxine. He does not trust the generic thyroid meds at ALL. So it doesn't seem to be a one-off situation.

BigLuca: OhLuverly: So glad I'm in hospital pharmacy instead of retail pharmacy now. Retail pharmacies are going to be dealing with weeks of patients insisting on brand named everything (99% which isn't stocked in pharmacies anymore)

Tech, PharmD, or student?

Certified Tech for the moment. Considering going to school to do something I actually like. I love hospital compared to retail, mostly because when patients try to pull the bs of I'm allergic to generic percocet I can only take brand we say oh.. ok well how about some advil instead because all we have are generics. That allergy clears right up.

You come to the counter. I am on the phone with a drunk dude who wants the phone number to the grocery store next door. After I instruct him on the virtues of 411, you tell me your doctor was to phone in your prescription to me. Your doctor hasn't, and you're unwilling to wait until he does. Being in a generous mood, I call your doctors office and am put on hold for 5 minutes, then informed that your prescription was phoned in to my competitor on the other side of town. Phoning the competitor, I am immediately put on hold for 5 minutes before speaking to a clerk, who puts me back on hold to wait for the pharmacist. Your prescription is then transferred to me, and now I have to get the 2 phone calls that have been put on hold while this was being done. Now I return to the counter to ask if we've ever filled prescriptions for you before. For some reason, you think that "for you" means "for your cousin" and you answer my question with a "yes", whereupon I go the computer and see you are not on file.

The phone rings.

You have left to do something very important, such as browse through the monster truck magazines, and do not hear the three PA announcements requesting that you return to the pharmacy. You return eventually, expecting to pick up the finished prescription.....

The phone rings.

......only to find out that I need to ask your address, phone number, date of birth, if you have any allergies and insurance coverage. You tell me you're allergic to codeine. Since the prescription is for Vicodin I ask you what exactly codeine did to you when you took it. You say it made your stomach hurt and I roll my eyes and write down "no known allergies" You tell me......

The phone rings.

.....you have insurance and spend the next 5 minutes looking for your card. You give up and expect me to be able to file your claim anyway. I call my competitor and am immediately put on hold. Upon reaching a human, I ask them what insurance they have on file for you. I get the information and file your claim, which is rejected because you changed jobs 6 months ago. An a-hole barges his way to the counter to ask where the bread is.

The phone rings.

I inform you that the insurance the other pharmacy has on file for you isn't working. You produce a card in under 10 seconds that you seemed to be unable to find before. What you were really doing was hoping your old insurance would still work because it had a lower copay. Your new card prominently displays the logo of Nebraska Blue Cross, and although Nebraska Blue cross does in fact handle millions of prescription claims every day, for the group you belong to, the claim should go to a company called Caremark, whose logo is nowhere on the card.

The phone rings.

A lady comes to the counter wanting to know why the cherry flavored antacid works better than the lemon cream flavored antacid. What probably happened is that she had a milder case of heartburn when she took the cherry flavored brand, as they both use the exact same ingredient in the same strength. She will not be satisfied though until I confirm her belief that the cherry flavored brand is the superior product. I file your claim with Caremark, who rejects it because you had a 30 day supply of Vicodin filled 15 days ago at another pharmacy. You swear to me on your mother's'....

The phone rings.

.......life that you did not have a Vicodin prescription filled recently. I call Caremark and am immediately placed on hold. The most beautiful woman on the planet walks buy and notices not a thing. She has never talked to a pharmacist and never will. Upon reaching a human at Caremark, I am informed that the Vicodin prescription was indeed filled at another of my competitors. When I tell you this, you say you got hydrocodone there, not Vicodin. Another little part of me dies.

The phone rings.

It turns out that a few days after your doctor wrote your last prescription, he told you to take it more frequently, meaning that what Caremark thought was a 30-day supply is indeed a 15 day supply with the new instructions. I call your doctor's office to confirm this and am immediately placed on hold. I call Caremark to get an override and am immediately placed on hold. My laser printer has a paper jam. It's time for my pharmacy tech to go to lunch. Caremark issues the override and your claim goes though. Your insurance saves you 85 cents off the regular price of the prescription.

The phone rings.

At the cash register you sign....

The phone rings.

......the acknowledgement that you received a copy of my HIPAA policy and that I offered the required OBRA counseling for new prescriptions. You remark that you're glad that your last pharmacist told you you shouldn't take over the counter Tylenol along with the Vicodin, and that the acetaminophen you're taking instead seems to be working pretty well. I break the news to you that Tylenol is simply a brand name for acetaminophen and you don't believe me. You fumble around for 2 minutes looking for your checkbook and spend another 2 minutes making out a check for four dollars and sixty seven cents. You ask why the tablets look different than those you got at the other pharmacy. I explain that they are from a different manufacturer. Tomorrow you'll be back to tell me they don't work as well.

Now imagine this wasn't you at all, but the person who dropped off their prescription three people ahead of you, and you'll start to have an idea why.....your prescription takes so damn long to fill.

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