Are Generic and Brand-name Pills Created Equal?

Ed Tobias avatar

by Ed Tobias |

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I take a bunch of pills every day. Most of them are generics.

I’ve used baclofen to treat my leg spasticity, oxybutynin for my bladder, and modafinil to fight fatigue. There’s also atorvastatin to keep my cholesterol in check, and levothyroxine to do the same for my thyroid levels. All are generics.

Over the years, I’ve read many social media comments from people questioning whether generics are as effective as brand-name medications. Just a few days ago, I read a comment on a Facebook multiple sclerosis group from a woman who said she became ill when she switched from a brand-name disease-modifying therapy to its generic version.

But I’ve always ignored comments like that. The U.S. Food and Drug Administration says that generic medications “are just as safe and effective as their brand-name counterparts.” In the U.S., nine out of 10 prescriptions are filled using generics. My doctors have prescribed generics for me for years, never questioning their efficacy.

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Generics are certainly less expensive than brand-name drugs, and the latter might not even be covered by your insurance. My Medicare Part D plan charges $93 for a 90-day supply of Synthroid, a synthetic thyroid hormone, while its generic, levothyroxine, is only $3. Ditropan, to treat overactive bladder, isn’t covered by my Medicare Part D plan, but its generic, oxybutynin, is. The same is true for Provigil versus modafinil.

But lower cost shouldn’t mean lower quality, right?

Are generics and brand names really equal?

A recent New York Times opinion piece has made me wonder whether a generic is in fact as good as a brand name.

In 1984, U.S. lawmakers allowed pharmaceutical companies to duplicate brand-name medications whose patents had expired without conducting clinical trials of those generics. All they needed to do was prove the generics worked similarly to the brand names and show that good production practices were being followed

But Times editorial board member Farah Stockman believes that in order to keep their generics cost-competitive, pharmaceutical companies have been cutting corners, which includes shifting to overseas production and material sourcing. According to Stockman, an overall quality control problem exists now.

Cost versus quality

“The truth is, a pill is not just a pill,” Stockman writes. “A pill that was made in a top-notch factory with a spotless track record is better than one that was made in a plant that barely passed inspection. A pill that was stored in a cool dark place is better than one left baking on an airport tarmac for weeks.”

Stockman supports this belief by pointing to incidents such as the discovery of a probable carcinogen found in valsartan, a generic drug used to treat high blood pressure, and to some patients treated in New Zealand for depression who reported that their conditions worsened when that country’s national health service switched to a generic.

Did my quality fade?

The New Zealand problem makes me wonder about my own medications. Over the past few years, I gave up on some of my meds, thinking they’d lost their effectiveness after many years of use. I no longer use modafinil to treat my fatigue or oxybutynin for my bladder problems. I wonder if their reduced efficacy occurred because the medications were generics and their production quality deteriorated over the years. I also wonder if brand names might work better, and whether I should try them again.

I might, if I can afford them.

You’re invited to visit my personal blog at www.themswire.com.

***

Note: Multiple Sclerosis News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Multiple Sclerosis News Today or its parent company, BioNews, and are intended to spark discussion about issues pertaining to multiple sclerosis.

Comments

Brian K. O’Neill avatar

Brian K. O’Neill

The (our) FDA i# corrupt as the rest of them. You do what feels right for you!!!

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Tracy avatar

Tracy

I was on Ampyra for years. Then my prescription coverage made me switch to generic.
Two things happened—
1. Lost the Ampyra co-pay assistance so had to pay $60/month when I was paying $25/month before.
2. Generic brand caused diarrhea.

So I had to get a note from my doctor stating I was unable to tolerate the generic brand so I could get prescription coverage to cover the Ampyra.
All of this caused a 2 month disruption of taking my Ampyra daily.

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Judi Webster avatar

Judi Webster

Ampryra: Same as a previous reader. I had been on brand name Amprya for YEARS, new doctor, thought she was going to save me money. The generic caused me so many problems because of an allergic reaction. Sometimes, there can be ONE change and it is just not the same drug. For some reason, Amprya affects my electrical system with my brain and bladder too, if I stop taking it, I have to go to the bathroom every 20 seconds. Sometimes, I would rather pay more for the comfort I know I should have. I know that is crazy...

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Ed Tobias avatar

Ed Tobias

Hi Tracy,

Thanks for sharing. I'm glad you were able to eventually continue with the medication that was most effective and affordable.

Ed

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Jessie avatar

Jessie

Interesting. I've been on Synthroid for decades. The one time a Dr had me try a generic levothyroxin, my body reacted as though I stopped the medication completely...classic symptoms. Major Hair loss, weight gain, etc. Went back to Synthroid and have never had an issue since. (Thank God my oxybutynin still works fine!)

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Deborah Piens avatar

Deborah Piens

I too "had to" switch to generic Ampyra. It works a little but I'm back to using a walker. And my insurance won't cover any of the cost of the name brand. They told me it would be $7000 a month. Who can afford that?

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Jeff Bowden avatar

Jeff Bowden

Careful Ed, you could be opening Pandora's Box! Generics are, have been, and will continue to be preferred by all Insurance companies; financially they could not remain in business otherwise. We all know the FDA is responsible for the quality of all medications. They must be equivalent in effectiveness and no company will risk loosing their certification to sell in the US if their drugs were found otherwise. Just a whisper of malfeasance can devalue a company overnight! One of the largest - Israel's Teva Pharmaceuticals - manufactures drugs for the world. They guard their reputation emphatically and would take great issue with your suggestions.

Do keep in mind that because a company is based in the US sells the drugs, generic or not, they can and are manufactured elsewhere. Certainly there can be shipping issues in any country, the pandemic has messed up the world. But even suggesting, without any evidence, that drugs 'may' be left on the runway for 'days' is reckless, companies do know how to ship everything. I've received Avonex shipment in August in Alabama with Ice Packs frozen solid. It is done all the time. Why would you even question that?

People do build up a tolerance to drugs, conditions change and can interfere with other drugs. That's why we have so many. To claim that a drug lost its effectiveness when switching to a generic is ignoring the many other issues that could be causing that. I don't know and neither do you. Repeating rumors accomplishes nothing. Also, even with all the safeguards in place drugs can be defective, it's manufacturing. Mistakes do happen.

I know you are voicing a concern, I too have had that thought from time to time. But unless you have evidence that a drug company or the FDA is not properly performing due diligence please do not start careless rumors.

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Bob Marshall avatar

Bob Marshall

Regarding Modafinil, I took it until it cause elevated blood pressure. My neurologist suggested a sleep study to address fatigue symptoms. I am now using a CPAP and it has helped the fatigue issues immensely. You should ask your doctor for a sleep study. It's simple and can be completed in your home and may be the start to a less fatiguing day.

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Ed Tobias avatar

Ed Tobias

Thanks for the suggetion, Bob. I wrote a column a couple of months ago about how a multivitamin seems to help my energy level. Also, since I've been able to better control my bladder I'm sleeping through the night more often.

Ed

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Nancy Rochelle avatar

Nancy Rochelle

I’ve had problems with many generics since I first started having to take medications for pretty much anything.
There are a few generics that I’ve tolerated ok, but I’m a firm believer that there is a significant difference between brand name and generic.

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Ed Tobias avatar

Ed Tobias

Hi Nancy,

Yes, I think we all need to coordinate with our health care providers to find the best meds that we can afford. Unfortunately, affordability and efficacy don't always come together.

Ed

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Alice avatar

Alice

Thank you for this. I had researched this issue before and only found websites saying that they are chemically equivalent and therefore there should be no difference. I was trying to switch from amantadine to modafinil because the amantadine was making my skin splotchy (it was a temporary thing that would come and go, but it looked disturbing when it happened). I tried the generic modafinil and it didn't work for me. The brand name was $500 a month which seemed like a lot to pay just to not have splotchy skin, so I'm taking amantadine again. Truth is, I don't mind sticking with the amantadine. It has worked well for me for 20 years and with covid nobody sees my skin anymore anyway. Most of the time I get generics, but I do still wonder about the effectiveness of generics vs brand name for some medicines.

Reply
Ed Tobias avatar

Ed Tobias

Hi Alice,

Thanks for the comments. I think we all need to experiment, keeping our docs in the loop of course, to find the best combination of benefit and cost from our meds.

Ed

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Terry avatar

Terry

We found out 6 years ago brands and generics are not the same. My husband went to generic Wellbutrin and I went to generic Cymbalta. We were both sicker than dogs during the process…my husband for months. The release rate on the brands work well, while the generics might dump all at once but not steadily like the brand…but the ingredients are the same.

My Mom has taken generic Lipitor for years. However, last year she received a script from a different manufacturer and it made her sick. After narrowing down what might have caused the problem, we received a new script from the old manufacturer and she was fine. Even the manufacturers are not the same.

And Modafinal will never be better than Provigil. It’s just not as effective. But it’s supposed to be the same. Go figure.

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Ed Tobias avatar

Ed Tobias

Hi Terry,

That's an interesting observation about release rate. I'd wondered whether these extended-release products actually release evenly. Do you have any specific evidence, or reports, that this is so?

Ed

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Jeffrey avatar

Jeffrey

I'm unfortunately on 600mg of Lyrica daily (don't get me started on all the problems associated with that) and when I received generic 200mg as my Part D didn't want to to pay for it, it was as if I wasn't taking anything. I was in ALOT of pain. Dr. had to send a challenge detailing the situation and I'm back on brand name. When I tried liquid Lyrica as I've been desperately trying to wean down for 2 years it was even worse.

I've even noticed different brands of generics working better or worse than others. Baclofen, methadone Diclofenac, etc.

I

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Ed Tobias avatar

Ed Tobias

Hi Jeffrey,

Thanks for sharing that. If you take a look at the other comments you'll see that you have a lot of company.

Ed

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KARIN AUBREY avatar

KARIN AUBREY

years ago, i was on a blood pressure medication and the levothyroxine that i was filling at Walmart. they were using those pullout sleeved all in one things that cost $4 a month to fill, and they were made in China. When my Doc saw no improvement in my BP after 6 weeks, she bumped the dose and another 6 weeks saw little change. she asked where i was filling my meds. When i told her she GASPED out loud. She asked me to bring the meds in a few days later and took a few samples to send to the lab.. You guessed right.. they very little of what they were SUPPOSED to have in them. I obtained a script for the original dosage of lisinopril and went to Walgreen's with it and within 10 days my BP was coming down again.. they were also using a generic but it was from a reputable manufacturer here in the US

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Ed Tobias avatar

Ed Tobias

Hi Karin,

That's quite a story. Thanks for sharing.

Ed

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KARIN AUBREY avatar

KARIN AUBREY

I am shocked the Doc didn't do that to start with, especially if you were totally stable on the name brand to begin with. There is always a way to get an over-ride for stuff like that. Prior Authoizations are gotten all the time for MS drugs because none of them on any of the Plan D's formulary's. They MUST be authorized. I hate these companies.. I am going to switch mine this year because of all the ridiculous crap they put me thru the beginning of this year. they are still trying to get me to switch pharmacies now. every month they send me a letter saying "this would a less expensive choice" not for me tho because i am in phase 4 so i have no costs..

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Ellen L avatar

Ellen L

My daughter says she could not tolerate the generic thyroid medicine. So she pays for the "real McCOY!!. When I was on Copaxone, the pharmacy automatically switched me to the generic version when if first came out. I was upset they did not tell me. They said it was policy. Once I contacted my doctor to make sure I got the brand name, the pharmacy let me return the generic ones. I took Copaxone for 12 years and now I am not on any MS medication... savings thousands of dollars! My policy is if it works don't change it. I do take one generic drug and I guess it works- not issues with it anyway.

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Ed Tobias avatar

Ed Tobias

Hi Ellen,

I hate hearing about pharmacies switching medications without first checking with the patient. I know that their formularies change each year but a surprise switch like that really bothers me.

Ed

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Dorothy avatar

Dorothy

I was told, by a reputable source, that the binders used in generic drugs are different in brand named drugs. The binders introduce the drugs into the body. So generics are NOT identical to brand named drugs.

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Ed Tobias avatar

Ed Tobias

Interesting, Dorothy. Thanks for sharing. Was your source someone in the pharmaceutical industry?

Ed

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Heather avatar

Heather

There is a difference for me with Ampyra versus the generic. I used Ampyra for years and it significantly improved my walking. When I turned 65 and went on Medicare the insurance would not cover Ampyra. My walking became worse and fortunately the physical therapist could document my decline and I was able to get it again. I sure am glad I could begin Ampyra again! Many of my other medications are generic and all of them have the main ingredient with different fillers making them cheaper.

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Ed Tobias avatar

Ed Tobias

Hi Heather,

Thanks for sharing this. I've heard the same story from several people who were using Ampyra and than switched to the generic. I wonder how many neuros who prescribe Ampyra realize this is happening.

Ed

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BELINDA K LOVE avatar

BELINDA K LOVE

Since learning that the majority of the drugs in the USA are made in China, and often questioning the efficacy of generic drugs; I am left to wonder what to do. Everything is so political nowadays, and drug prices are so ridiculously high (especially brand names), how are we supposed to survive? When other cultures respect and revere its older population for their wisdom and knowledge - it seems that our younger people don't listen to us & actually want us to go away & die. I just don't understand.............

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Ed Tobias avatar

Ed Tobias

Hi Belinda,

I don't agree with you about our young people - at least that hasn't been my experience - but there certainly is a problem with the cost of health care in general. The political tug-of-war over solving it, I'm afraid, will never end.

Ed

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Carla avatar

Carla

Yes generic is different. It's not as good as name brand. I am on copaxone. They tried to put me on generic. Broke out in a rash. Life is challenging enough. I fought the insurance. My NP fought for me. Now I am still on name brand. You have to fight for what is important for oneself. Carla

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Ed Tobias avatar

Ed Tobias

Hi Carla,

Thanks for sharing that info. If you read the other comments you'll see that you're not alone. I'm glad you had an NP who stood up for you.

Ed

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Terry avatar

Terry

Hi Ed: regarding release rates of brand vs generic drugs and documentation…I’ll need to do some backtracking on my research from when my husband and I had problems. We did find a site if I recall confirming it was an issue that FDA should look into. I’ll post when I find it.

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Ed Tobias avatar

Ed Tobias

Thanks, Terry. That'll be interesting info, if you can find it.

Ed

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Anthony Hoysted avatar

Anthony Hoysted

I've taken brand names and generics of different medications over the years and never noticed any difference between them in either efficacy or side effects. The largest generic medication manufacturers are multi-billion dollar companies in their own right, some having tens of thousands of employees. In some cases the generic manufacturer is part of a group that also markets well-known name brands. For example, the Upjohn name, most recently used to market off-patent medications, was owned by the well-known brand-name manufacturer, Pfizer. More recently, Upjohn has merged with the generic manufacturer Mylan. My feeling is that these companies, whether generic or brand-name, will manufacture to the same standards.

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Ed Tobias avatar

Ed Tobias

Hi Anthony,

I hope you're right. One of the problems is that, even if we know the manufacturer, it's difficult, if not impossible, to determine the actual manufacturing location, or the source of the ingredients in the meds, when we fill a script.

Ed

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Terry avatar

Terry

Hi Ed: I found several articles on the subject that may be of interest. Although I’m not a regular reader of VICE, the writer’s personal experience and research is informative. Her article also mentions the disaster with generic Wellbutrin such as my husband experienced. The second article is from Merck Manuals. Evidently there is a short list of brand drugs that should not be substituted for generics. My guess is that list should be substantially longer.

https://www.vice.com/en/article/v7mnm3/my-generic-medication-gave-me-constant-nosebleeds-im-not-alone

https://www.merckmanuals.com/home/drugs/brand-name-and-generic-drugs/bioequivalence-and-interchangeability-of-generic-drugs

Terry

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Penny-Marie Wright avatar

Penny-Marie Wright

I have 4 drugs right now that don't seem to be doing anything so maybe I should check them out as I usually get generic. Years ago I had 1 that had to be name brand but with my doctor's letter had no problem getting it. I've only been on 1 MS drug, Rebif, when first diagnosed 20 years ago but had to quit it because it started affecting my liver. Now my neurologist says there isn't another that would help me even with so many out there now.

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Ed Tobias avatar

Ed Tobias

Hi Penny-Marie,

I don't know where you are in your MS journey but, if I were you, I'd get a second opinion about a different MS medication. As you say, there are so many available and many of those are far more effective than Rebif.

Ed

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nicola doyle avatar

nicola doyle

Mmmm interesting article. I have recently been able to cut my citalopram dose by half ( from 20 to 10mg) and was doing very well ( 4 months ) until I was supplied with a generic. The blues came flooding back! As usual one thinks must go back up to the old dose. No, I'm going to insist on the previous brand and see how I go ;)

Reply
Ed Tobias avatar

Ed Tobias

Good luck, Nicola. Check back and let us know how your brand name request goes.

Ed

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