Crippled by cost of copays:(

[susianew]

I would suggest you check out the FDA page on myths and facts about generic drugs:

http://www.fda.gov/Drugs/ResourcesF...afely/UnderstandingGenericDrugs/ucm167991.htm

Espicially this part:
MYTH: FDA lets generic drugs differ from the brand name counterpart by up to 45 percent.
FACT: This claim is false. Anyone who repeats this myth does not understand how FDA reviews and approves generic drugs.
FDA recently evaluated 2,070 human studies conducted between 1996 and 2007. These studies compared the absorption of brand name and generic drugs into a person’s body. These studies were submitted to FDA to support approval of generics. The average difference in absorption into the body between the generic and the brand name was only 3.5 percent [Davit et al. Comparing generic and innovator drugs: a review of 12 years of bioequivalence data from the United States Food and Drug Administration. Ann Pharmacother. 2009;43(10):1583-97]. Some generics were absorbed slightly more, some slightly less. This amount of difference would be expected and acceptable, whether for one batch of brand name drug tested against another batch of the same brand, or for a generic tested against a brand name. In fact, there have been studies in which branded drugs were compared with themselves as well as with a generic. As a rule, the difference for the generic-to-brand comparison was about the same as the brand-to-brand comparison.
Any generic drug modeled after a single, brand name drug (the reference) must perform approximately the same in the body as the brand name drug. There will always be a slight, but not medically important, level of natural variability – just as there is for one batch of brand name drug to the next.

Brand name drug companies spend millions of dollars every year convincing doctors that only their product will work. (My favorite was when Protonix went generic and the drug rep came in to our pharmacy to tell us how much better brand name Protonix was than the generic. He was unaware that the makers of Protonix were also producing the generic...we would open a bottle of the generic and there would be little white pills with "PROTONIX" printed on them- so the brand and generic were literally coming off the same production line and the bottles were just labelled differently.)

I would talk to the doctors again and let them know the impact this is having on your life. You also might try going for a consult with a neurologist in another area or at a teaching hospital to get their input. (Prescibing habits can be very local.) I think the idea of switching to generic with a very slight increase in dose is a good idea too- although I think the benefit of the increased dose is probably more psycological than anything else.

All but one of the patients at our pharmacy has switched to generic Keppra, and we hardly do any brand name Depakote, Dilantin, Lamictal, or Topamax anymore. The one local neurologist that still worries a lot about generics always writes on his scripts "Patient may have generic, but must stay on the same manufacturer's generic unless physician is consulted about a change".

Good Luck!

 

[kaytieeldr]

All but one of the patients at our pharmacy has switched to generic Keppra, and we hardly do any brand name Depakote, Dilantin, Lamictal, or Topamax anymore.

Now, it's funny. I was on Dilantin for close to eighteen years (overlapped with the Topamax for a few) and the generic scared me - because it's a time-release capsule. Also, I had a different insurance plan at the time so the copay difference was acceptable. But I had - have - NO problem with the toperimate

 

[Coll0610]

You might want to post on the disabilitie board too. I'm sure there is a lot of experience there working with insurance companies!

 

[undertheradar]

I would suggest you check out the FDA page on myths and facts about generic drugs:

http://www.fda.gov/Drugs/ResourcesF...afely/UnderstandingGenericDrugs/ucm167991.htm

Espicially this part:
MYTH: FDA lets generic drugs differ from the brand name counterpart by up to 45 percent.
FACT: This claim is false. Anyone who repeats this myth does not understand how FDA reviews and approves generic drugs.
FDA recently evaluated 2,070 human studies conducted between 1996 and 2007. These studies compared the absorption of brand name and generic drugs into a person’s body. These studies were submitted to FDA to support approval of generics. The average difference in absorption into the body between the generic and the brand name was only 3.5 percent [Davit et al. Comparing generic and innovator drugs: a review of 12 years of bioequivalence data from the United States Food and Drug Administration. Ann Pharmacother. 2009;43(10):1583-97]. Some generics were absorbed slightly more, some slightly less. This amount of difference would be expected and acceptable, whether for one batch of brand name drug tested against another batch of the same brand, or for a generic tested against a brand name. In fact, there have been studies in which branded drugs were compared with themselves as well as with a generic. As a rule, the difference for the generic-to-brand comparison was about the same as the brand-to-brand comparison.
Any generic drug modeled after a single, brand name drug (the reference) must perform approximately the same in the body as the brand name drug. There will always be a slight, but not medically important, level of natural variability – just as there is for one batch of brand name drug to the next.

Brand name drug companies spend millions of dollars every year convincing doctors that only their product will work. (My favorite was when Protonix went generic and the drug rep came in to our pharmacy to tell us how much better brand name Protonix was than the generic. He was unaware that the makers of Protonix were also producing the generic...we would open a bottle of the generic and there would be little white pills with "PROTONIX" printed on them- so the brand and generic were literally coming off the same production line and the bottles were just labelled differently.)

I would talk to the doctors again and let them know the impact this is having on your life. You also might try going for a consult with a neurologist in another area or at a teaching hospital to get their input. (Prescibing habits can be very local.) I think the idea of switching to generic with a very slight increase in dose is a good idea too- although I think the benefit of the increased dose is probably more psycological than anything else.

All but one of the patients at our pharmacy has switched to generic Keppra, and we hardly do any brand name Depakote, Dilantin, Lamictal, or Topamax anymore. The one local neurologist that still worries a lot about generics always writes on his scripts "Patient may have generic, but must stay on the same manufacturer's generic unless physician is consulted about a change".

Good Luck!

 

[Pembo]

Good luck to you and definitely look into your state's insurance programs for kids with disabilities. Seizure disorder is a disability.

 

[LoveBWVVBR]

Good luck to you and definitely look into your state's insurance programs for kids with disabilities. Seizure disorder is a disability.

A little OT, but how do you find out what is considered a disability for these state insurance programs? I was told that my oldest should qualify based upon her hypotonia diagnosis, but when I called they made it really confusing and I gave up. Her PT costs us $127.50/week because Blue Cross doesn't cover it, so I'd love to have access to the state insurance program for her even if I have to pay a premium for it.

 

[mickeymom1]

I am not sure if it is the same in all states, but in NJ there is no insurance for a child based on a disability alone. It is ultimately based on the parent's income level. My son has down syndrome which I don't think could ever be a "questionable" disability and there is no state insurance or program that he is eligible for because we do not meet the financial criteria.

 

[Zoemakes5]

I had a similar situation with birth control...I had tried a number of them and then tried one that we discovered was non-formulary. They denied it and then my doctor sent in a letter detailing how I had tried the formulary versions and they didn't work so I needed this one and the insurance company covered it. AND my copay was just a regular one.
I've had to do that in the past to get coverage for Zyrtec, too, when it was an "off formulary" drug. Claratin was the one to take.
My situation wasn't dealing with generic, but non-formulary.
My grandfather had generic issues in relation to one of his heart medications and he was successful, but it was YEARS---well decades ago.
Good luck!

 

[Tink-aholic]

I do believe it is totally unnecessary for the drug companies to charge what they do for meds that are so needed.

While I do hope the OP does find relief for her family and can find either a cheaper solution or help to pay for the meds, I'd like to address this point.

The drug companies must pay MILLIONS of dollars over more than a decade to get a new drug on the market. They only have a relatively short window to recoup that money before their patent on the formula is given out to any company who wants to make a copy of it as a generic.

The drug companies are a business. They charge what they do so that they can actually make a profit during that window of time. Otherwise, drug companies wouldn't be in business and there would be no new drugs for any of us.

I bet if you invested millions of your own dollars into your own research for your own formula and waited twelve years for the payoff, you'd want to be paid back for it, right? If you were paid well enough, it might just make you want to go through the whole process again and make another drug.

 

[prncess674]

Sounds like you haven't even tried the generics and your doctor is overly protective of his drug rep lifestyle. Drug reps love doctors who swear by name brand only and they take care of your doctor handsomely. I find it highly suspect that both of them are required to take name brand only. Did either of them even try the generic and suffer any ill effects? Also have you discussed with your doctor the negative mental effects you are suffering by so much of your income going to drugs. Mental health distress can be just as debilitating. I agree with others who say you should get a second opinion on whether name brand is needed.

Have you done any research to determine what manufacturer makes your name brand and also the generic. As others have pointed out it is the same person and the EXACT same thing. Once you find out which manufacturer makes both you can then talk to a few pharmacists around town and find out which one gets their generic from that manufacturer.

Fighting the insurance company is going to be a losing battle since the drug IS covered, just not at the generic price that you prefer. If the insurance was denying any coverage then you might have a case. What other policy options do you have at your company? You are probably too late for annual enrollement but start doing your research for next year.