The generic medicine juggernaut rolls on

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

Just over half of all prescriptions sold in this country are now generic drugs. Before long, these copycat medicines will dominate the market.

That's because some very popular brand-name medications are losing their patents. Drugs like the sleeping pill Ambien, the cholesterol-lowering drugs Pravachol and Zocor, and the antidepressant Zoloft will soon be up for generic competition.

Insurance companies, government health programs and ordinary citizens will all be able to save billions of dollars when the new generics come on line.

To give you some idea of the savings, just check out the price of Prozac. This popular antidepressant can cost about $140 for a month's supply. The generic fluoxetine is closer to $20.

To entice people to switch from pricey brands to the generic equivalents, some insurance companies are suspending co-payments for up to six months. In essence, the consumer is getting his generic medicine for free.

That's a pretty big carrot. Then come the sticks. Many insurance companies now have a multitiered co-pay structure. If you are taking a generic drug, the cost is often modest, only $5 or $10. If you take a brand that is on the preferred list (formulary), the co-pay may be $25 or $30. But if your doctor insists that you take a brand-name drug that is not on the formulary, you might end up paying $50 or $60 for that prescription.

Insurance companies are desperate to control their ever-escalating drug bills. Switching patients to less-expensive generics is their solution.

From a purely bottom-line perspective, generic drugs are a great deal. Who wouldn't want to get the same medicine for much less money? But how good are generic drugs?

There was a time when the big brand-name manufacturers used to bad-mouth generic medicine as inferior. These days, they have joined the bandwagon. The giant pharmaceutical company Novartis that makes brand-name medicines is also striving to become a major player in the generics field.

The competition is stiff, however. Generic companies from all over the world (Israel, India and Brazil) are vying for market share. Price is often the deciding factor when wholesalers and hospitals decide which generic drugs to buy.

According to the Food and Drug Administration, all generic drugs licensed in the U.S. must go through a rigorous approval process to demonstrate that they are equivalent to the "innovator" compounds. But the real issue is: Who is monitoring the marketplace after a generic drug is approved?

The FDA is supposed to visit every drug manufacturing plant (big brand names or little generics) every two years. But agency officials admit that they don't have the manpower to accomplish this goal.

More worrisome is the danger of counterfeits or substandard products. For the most part, the government relies on the honor system. FDA staffers have told us that they analyze about 300 pill bottles a year to make sure they contain what they claim. This amounts to about one in 10 million.

If unscrupulous manufacturers and wholesalers slip poor-quality products into the supply chain, it is unlikely that anyone will catch them. Generic drugs do offer substantial savings, but consumers will need to be vigilant to make sure they are getting their money's worth.

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