OT: any pharmasists here?

[zoemurr]

Please help me understand this.

I have been taking a medication for about 3 years with annual refills. I go to the same pharmacy every month to pick it up.

Tuesday I went to get it. She said it was $5. My co-pay is usually $25 so I mentioned it. I looked at the bottle and said it wasn't the right Rx. They told me that it was the generic and that it just came out and that they had to give me that by law.

I don't want something brand new (even though I'm sure it's fine) and told them I wanted what they've been giving me every month.

They said if there is a generic available they aren't allowed to give me the brand name unless the dr. said so, even though they have given it to me 50+ times already.

I don't really get it as I've been taking it for ages and I agreed to the higher $. They said they would call my dr. and figure it out and fill it but I haven't heard anything. Not happy that they need to bother my dr. with this.

Can I just go to another pharmacy and hope they don't have the generic in stock?

I understand that the law is in place so people don't get ripped off... but why is it not ok if I agree to it? I'm in NY.

 

[camlace]

Your doctor needs to check the "No Subsitutions" box on your prescription if you want the brand name. Most insurance companies require the pharmacy to dispense the cheaper generic if available. Even with the No Substitutions box checked, some insurance companies chose not to cover the brand name if a generic is available. I have had this happen many times over the years as patents run out on brand name drugs and generics are manufactured.

 

[pumba]

this has happened to us as the time on the patent goes away and the generic comes out......I have been on the generic for some meds for a year and no difference in my numbers ...so I am assuming that it is the same ingredients as the high test product..

 

[skw444]

Most insurance companies require the pharmacy to dispense a generic if one is available UNLESS the doctor specifies on the prescription that it is "Brand necessary". Talk to your doctor about wanting the brand specific med and he should be able to write you a new prescription.

 

[RMulieri]

The pharmacist is correct.Your Dr needs to specify "No substitutions" otherwise legally they have to give generic if there is one.Insurance companies also will not reimburse if a brand is given when a generic is available ( unless the Dr stipulated it beforehand).Call your Dr.

 

[Ephany]

In some states the doctor is required to write (not stamp, not check a box) ' brand medically necessary' as well as sign the rx. This does not mean your insurance will still cover brand, you may have to pay out of pocket if it's no longer on their formulary. If brand is still covered, it's likely your copayment may increase as they want you to get generic.

 

[MomRN]

Not a pharmacist, but a nurse, and I know our hospital pharmacy will sometimes substitute meds, sometimes completely different meds. Our drs have to write the order as "do not substitute"

Often this is when our pharmacy wants to switch a brand for a cheaper one (because of insurance reasons). If the generic version has the same chemical properties as the name brand, the insurance will only pay for the generic many times as I understand. In those cases pts bring in their meds from home and we dispense those.

 

[zoemurr]

I spoke with someone at the pharmacy again. No one called my dr. like they said they would. So someone else is doing it today. I can't believe I didn't get the first girl's name.

Since the generic is new the insurance will continue to cover the brand name for a few more months at least. Enough time for me to discuss it with my dr. I was told that the generic is not always identical and not always a good fit for a patient.

So, they're going to call my dr. and hopefully she will say this is ok for now. Guess I'm making a mountain out of a molehill but I hate meds and I do fine on this one and don't want to risk any problems with a brand new med.

 

[RMAMom]

Don't wait for the overworked pharmacy to take care of this. Call your Dr and ask them to call the pharmacy for you. Have your pharmacy # ready to give to them. This happens all the time!

 

[PiperPizzaz]

Be prepared for your name brand to cost you more now too. Once the generic comes out I have found my insurance company moves the original to a higher level.

 

[zoemurr]

the 2nd time they promised me, and it was taken care of and filled in about 2hrs.

I was promised that my co-pay would be the same for now, but that it might change later.

 

[tartemis]

Generic medications, by law, are required to have the same active ingredients as Brands. The inert ingredients, however, may be defendant.

In virtually all instances, the generic medication will work the exact same for a patient as the Brand. There is anecdotal evidence that with some epilepsy and psychotropic medications, the inert ingredients do make a difference and the generics may not work as well as the brand (to be more accurate, it is that generic and brand may affect the patient differently; in some instances the generic may work better than the brand). Accordingly, in some states (not sure about NY) they exempt those type of drugs from mandatory substitution laws.

It sounds like everything has worked out for you for now, but I personally wouldn't sweat it if your insurance eventually won't cover it -- I would just switch to the generic.

 

[Mandychelle79]

Generic medications, by law, are required to have the same active ingredients as Brands. The inert ingredients, however, may be defendant.

In virtually all instances, the generic medication will work the exact same for a patient as the Brand. There is anecdotal evidence that with some epilepsy and psychotropic medications, the inert ingredients do make a difference and the generics may not work as well as the brand (to be more accurate, it is that generic and brand may affect the patient differently; in some instances the generic may work better than the brand). Accordingly, in some states (not sure about NY) they exempt those type of drugs from mandatory substitution laws.

It sounds like everything has worked out for you for now, but I personally wouldn't sweat it if your insurance eventually won't cover it -- I would just switch to the generic.

My daughters ADHD med went generic last summer and I was excited, lower copay. Yeah generic adderall xr did not work with my dd at all, and made her worse. We now have the dr write brand medically needed and it gets covered.

 

[parkers218]

I am a pediatric nurse and we had ALOT of kids come in with seizures last summer who had been stable for months (some even years)..at first no one could figure out what the problem was..later we found that ALL of these patients had been switched to generic drugs...So it does make a big difference depending on the sickness

 

[Nancyg56]

In some states the doctor is required to write (not stamp, not check a box) ' brand medically necessary' as well as sign the rx. This does not mean your insurance will still cover brand, you may have to pay out of pocket if it's no longer on their formulary. If brand is still covered, it's likely your copayment may increase as they want you to get generic.

This happened to my DH. He was sent the generic so I called the mail order pharmacy our insurance plan uses and was told it was the same. Yes it was...except that my DH's throat closed. Now we need to order it from our local pharmacy on a monthly basis and must pay a much higher co-pay.

 

[bear_mom]

There are certain classes of drugs, antiseizure, is one, where you are supposed to stay on the type you start. If you start on name brand, you stay on name brand, if you start on generic, you stay on generic.

Other times, it often (read: not always) doesn't make a difference if you take the name brand or generic.

Emily

 

[Mandychelle79]

There are certain classes of drugs, antiseizure, is one, where you are supposed to stay on the type you start. If you start on name brand, you stay on name brand, if you start on generic, you stay on generic.

Other times, it often (read: not always) doesn't make a difference if you take the name brand or generic.

Emily

True Emily. My kids have taken generic of just about everything with no problem. My dd just cant metabolize the inert portion of the generic xr.