Brand Name or Generic?: How to save on prescriptions
By Bridget Avila
Soaring prices have everyone looking for ways to be frugal. So when we’re faced with purchasing medications, cheaper generic treatments may seem like the logical choice. But what’s the real difference between generic and brand-name drugs? Why would a doctor prescribe a more expensive medication when a less expensive option is available? How do we know we’re getting what we’re paying for?
Same Drug, Less Dough
When you’re sick and miserable and ready to beg and plead for your health care provider to help you do something—anything—to feel better, that little prescription pad may seem like a magic wand, or maybe a magic eight-ball. But physicians aren’t magicians. They have treatment protocols to follow. Certain classes of medications treat certain conditions. They may choose one drug over another because of your medical history or their observations.
So, should you talk to your doctor about buying generic? Saving some 80 percent of the price of a prescription could be an incentive. Once a new drug has been on the market for 20 years (and sometimes less), the manufacturer loses patent protection. Then other companies can sell generic formulations of the same medication for a fraction of the price charged under patent protection. Some might worry that generic drugs might be of lesser quality than brand-name drugs, but all medications are subject to the same FDA scrutiny for safety, strength, and efficacy. So what’s the difference? Price.
More than half of prescriptions dispensed in the United States are generics, but generics account for less than 16 percent of total spending on prescription drugs. You can call any pharmacy to learn the different prices of a brand-name drug and its generic, but here are a few examples of medications for common illnesses (prices provided by CVS.com).
| Condition |
Drugs (brand name/
generic) |
Amount |
Brand Price |
Generic price |
% Price Difference |
| Asthma |
Ventolin/
albuterol |
(4) 90-mcg inhaler |
$39.09 |
$25.99 |
50% |
| Hypertension |
Prinivil/
lisinopril |
20-mg tablets, 90 |
$152.99 |
$38.89 |
293% |
| Congestive heart failure |
Lasix/
furosemide |
20-mg tablets, 90 |
$37.99 |
$17.09 |
122% |
You can save even more with retailers that sell a 30-day supply of more than 300 different generic drugs for just $4 each. These include Wal-Mart, Sam’s Club, Kmart, and Target as well as some membership warehouse and grocery store chains. Walgreens offers 90-day prescriptions for some 400 generics for $12. For medications for chronic conditions, mail-order programs (now a benefit of most employers) could be a good option.
Experts caution consumers looking for low drug prices to steer clear of importing drugs (except in person from Canada) or buying drugs online from Canada. It’s illegal and potentially dangerous, as the drugs sold under these circumstances could be fake, weak, or tainted.
When It Pays to Pay More
There are circumstances in which generic drugs are not the best choice. Occasionally a breakthrough treatment does come onto the market. Such newer drugs, that are significantly more effective at treating an illness than older remedies, may be worth the extra money. Doctors may also choose newer therapies if they have lesser side effects than their older counterparts.
While generics have the same active ingredients as the name brand drug, the inactive ingredients can be different. The inactive ingredients can affect how quickly the drug is absorbed into your system. Some drugs have a very narrow therapeutic range and the small change in absorption rate can make a huge difference in the drug’s effectiveness.
In the state of Maryland, pharmacists are legally allowed to dispense a generic in place of the drug your doctor writes the prescription for as long as your doctor does not specify “DAW” which stands for “dispense as written.” This means if you are concerned about cost, you can request a generic directly from your pharmacist; however, the best approach is to discuss the choice of drug treatment with your doctor when he or she is writing your prescription.
Some argue that biologics—drugs made by life forms such as cells, yeasts, or bacteria—should only be bought from their patent holders. Examples of biologics include a range of drugs, from common vaccines to cutting-edge cancer treatments or therapies for rare muscular disorders. The manufacturing process involves programmed cell lines that produce a desired protein in a highly controlled environment. The argument is that biologics are much more complex in structure than other medications and they involve several orders of magnitude, more atoms than common medications that are simpler to copy. Therefore comparable biologics produced by different cell lines may produce different clinical effects.
Legislation currently before Congress would affect the patenting of biologics. At press time, debate among the pharmaceutical and political players about whether generic biologics should have mandatory clinical trials continued. Other types of generic drugs don’t require such trials, as efficacy and safety were tested with the initial brand-name product. The end result of the legislative efforts may or may not make it easier for drug manufacturers to safely and effectively produce generic versions of biologics.
Seduced by Marketers?
As much as your physician might have your best interests at heart, he or she can still be swayed by the powerhouse that is the pharmaceutical industry. As John D. Abramson, author of Overdo$ed America, describes his own experience as a doctor, even the most conscientious health care providers can find themselves writing prescriptions for costlier medications than they needed to. Abramson followed pharmaceutical research closely and kept up with the latest medical guidelines, all while maintaining his distance from drug company salespeople.
But, like many doctors, he used the free samples of medications pharmaceutical representatives delivered to his office. He handed them out to uninsured or financially challenged patients. “I thought I was being Robin Hood,” he said in Science News magazine. Then he grew so accustomed to administering these free medications that he began writing prescriptions for the same brands for patients whose insurance would pay for them. “That’s what they wanted,” he said. “They were playing me like a violin.”
In addition to the free sample strategy, pharmaceutical companies target physicians with ads in medical journals and use mass media advertisements to urge people to ask their doctors about specific brand-name drugs. Such direct-to-consumer (DTC) advertising is not permitted in Europe and is strictly limited in Canada, while in the United States it’s grown into a multibillion-dollar industry over the past decade. The pharmaceutical industry argues that such promotion better educates patients and doctors about available treatments. But consumer advocates argue that ads and giveaways push doctors into prescribing unnecessarily expensive—or, what’s worse, suboptimal—treatments.
One study sent actors to physicians’ offices prepared to describe certain realistic sets of symptoms (much like “standardized patients” who help medical students learn diagnostic skills). When the actors faked major depression but didn’t ask for an antidepressant outright 31 percent received a drug prescription. But when they mentioned a television program that urged them to seek treatment, 76 percent received a prescription of some kind.
Physicians view DTC advertising as a double-edged sword. In a survey of 643 U.S. physicians, nearly 75 percent said they believe that DTC ads inform people about potentially beneficial treatments, and 66 percent said the ads improve doctor-patient communication as 25 percent of the ad-initiated conversations lead to diagnoses that might have otherwise gone undetected. But 80 percent of the doctors in the survey said that ads encourage patients to seek unnecessary treatments without fully detailing the drugs’ risks.
Watching Out for Your Health—and Your Wallet
It is easy to forget that you are a medical consumer, responsible for advocating for your own health and a fiscally responsible way to achieve it. So before you accept a prescription from your doctor, think about your alternatives:
- Consider nondrug therapies first
- Ask for a generic drug prescription if that’s medically appropriate.
- If your health care provider prescribes a newer drug for which there are no generics, ask why this drug is preferable to older, less expensive treatments.
- Steel yourself against drug advertising. Print and television ads are designed to play on fear and downplay adverse side effects.
Bridget Avila writes frequently about health issues for What’s Up?
. She has worked in health care and science policy organizations.
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dec 08
bridget avila
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