Prescription medications can sometimes be more than you bargained for

By JOE GRAEDON AND TERESA GRAEDON, Ph.D. Published:

For years, we have been critical of "me-too" drugs. These are copycat medicines. When a pharmaceutical company comes up with a brilliant new compound, it doesn't take competitors long to create variations on the theme.

For example, Prilosec (omeprazole) was the first "proton pump inhibitor" (PPI). It was introduced as a new and more powerful way to suppress stomach acid and fight reflux. Prilosec became a billion-dollar success and one of the most prescribed drugs in the country.

Other companies followed up with their own PPIs. Now we have Aciphex, Nexium, Prevacid and Protonix.

Viagra certainly made a splash when it came along as the first pill for erectile dysfunction. Now there's also Cialis and Levitra.

Drug companies justify these me-too medications on the grounds that they often represent improvements on the original compound. They point out that some patients may not respond well to the original product, or that longer-acting variations offer advantages.

We used to think that these were just excuses the companies used to rationalize getting into a lucrative new market. But we have come to recognize that not all drugs in a class are created equal.

Several years ago, we heard from a mail carrier about his experience with drug substitution. He had taken Zantac for years to treat severe heartburn brought on by a hiatal hernia. It kept the condition under control with no side effects.

His managed-care company decided to save money on his prescription and had his doctor switch the prescription to cimetidine (generic Tagamet). In theory, the two drugs work in a similar fashion.

In less than two weeks, though, the mailman had developed pancreatic inflammation and was in the intensive-care unit of the hospital. He nearly died and needed months to recover.

After he was discharged from the hospital, his insurance company still refused to cover Zantac. That is despite the fact that his doctors confirmed that cimetidine had caused his life-threatening complication that had cost the managed-care company tens of thousands of dollars. He paid for his next Zantac prescription out of his own pocket.

Insurance companies often establish favorable relationships with certain drug companies. That means that those firms' medicines are included on the approved list, while others are left off. If the doctor writes a prescription for a drug that is not on the list, the co-pay can be $50 or more each month. In some cases, patients might have to pay for the entire cost out of pocket.

The new Medicare Plan D program providing prescription drugs for senior citizens is full of such pitfalls. An insurance company might have only one or two drugs in a particular category.

It's a travesty when, instead of your doctor, bureaucrats who know nothing about your specific medical history make decisions about the drugs you should take.

We are strongly in favor of people being able to save money on medicine when they can. But we also advocate individuals using the medicine that works best for them, with the fewest side effects. That does not always correspond to the insurance company's objective to save money at all costs.

Joe Graedon is a pharmacologist. Teresa Graedon holds a doctorate in medical anthropology and is a nutrition expert. Their syndicated radio show can be heard on public radio. In their column, Joe and Teresa Graedon answer questions from readers. E-mail them via their Web site: www.PeoplesPharmacy.com.

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