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On Generic And Brand Name Drugs

Submitted by Georgie Porgie on request from BU in light of the current debate around generic and brand name drugs   Every drug has a generic or chemical name, which often tells us some thing about the chemistry of the drug. In addition, the generic name of a drug allows physicians, pharmacologists and other health…

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Submitted by Georgie Porgie on request from BU in light of the current debate around generic and brand name drugs

 

Every drug has a generic or chemical name, which often tells us some thing about the chemistry of the drug. In addition, the generic name of a drug allows physicians, pharmacologists and other health professionals to have a universal nomenclature for a specific chemical formulation. For example paracetamol, or acetamenophen is the name of a commonly used non steroidal anti inflammatory drug.

A generic or chemical name allows us to identify a particular chemical compound anywhere we go in the world.

Generic names are used universally and allow for international discussion on pharmaceuticals.

GENERALLY WE DISCUSS DRUGS BY THEIR GENERIC OR CHEMICAL NAMES

Drugs also have Proprietary or brand name(s). This is a name or identification given by drug manufacturers to isolate their product from other similar chemical formulations. A Proprietary or brand name is a name used to sell, prevent copying and label drugs.” For example in the Caribbean and British Commonwealth, paracetamol (acetamenophen) is available as Calpol, Panadol, Cetamol, Paramol. In the USA, acetamenophen is marketed as Tylenol among others.

One can l pick up information on proprietary or brand names for your area when you see visiting drug representatives, and in publications like MIMS, or Physicians Desk Reference etc. It is not easy to keep up with all the brand names of a particular drug but it is helpful to be aware of those that are available in one”s community, state, country etc. as is most relevant to you.

BRAND NAME DRUGS are SIMILAR OR THE SAME AS GENERIC DRUGS IN THE SENSE THAT THEY OUGHT TO/CONTAIN THE SAME CHEMICAL SUBSTANCE.

HOWEVER, BRAND NAME DRUGS are different from GENERIC DRUGS DEPENDING ON THE FIRM THAT MAKES THE GENERIC DRUG

SOME TOP NOTCH FIRMS MAY MAKE THEIR DRUG AND SELL IT TO OTHER FIRMS IN BULK AS A GENERIC FOR REPACKAGING AFTER THEY HAVE LOST THEIR PATENT.

YOU CAN THEREFORE GET THE SAME DRUG VERY CHEAPLY FROM A BRAND NAME FIRM MARKETED UNDER A DIFFERENT NAME OR FROM ONE OF ITS SUBSIDIARIES OR A FIRM THAT BUYS GENERICS FOR REPACKAGING

However, there are a number of companies that make generic drugs that are way below standard, with respect to how they are pressed or formatted/formulated. For example when the Drug Service began in 1980 many of our hypertensive patients on the island who were controlled on MSD’s brand name drug ALDOMET (generic name methydopa) went out of control when we started using the cheaper methyldopa from CARLISLE.

A popular generic firm used by the Barbados Drug Service (BDS) is Biochemie from Italy or Apo from Canada………not too good in my estimation. At the same time most brand name drugs are over priced as the firms that made them seek to recoup their costs.

32 responses to “On Generic And Brand Name Drugs”

  1. David Avatar
    David

    Sensible changes to drug formulary

    6/10/2011

    The continuing controversy about the rationalisation of the Barbados Drug Formulary and the fees to be paid for any prescriptions if filled at private pharmacies calls for some sober and logical comment.

    There are two issues that have been challenged repeatedly in the press and public dialogue, either through a lack of understanding or through vested interests of one kind or another.

    The first is the matter of the reduction of drug choices. In matters of fashion and clothes, choice of motor cars or choice of food, people enjoy a vast variety of choice and spend their money as they choose. When government is attempting to provide comprehensive health care, however, unlimited choice is unaffordable, unnecessary and unreasonable. In the case of the Barbados Drug Service and National Drug Formulary it has driven drug expenditure by government to huge sums, which are unnecessary and wasteful.

    Most doctors prescribe from a limited number of drugs or medicines; studies we did some years ago showed that our primary care doctors prescribed from a range of far less than 100 drugs. Yet our National Drug Formulary had grown dramatically to provide some 700 choices! These include some 25 pain killers and anti-inflammatory drugs, and more than 50 drugs for hypertension. These include several examples of 5 – 7 drugs in the same category, with little difference between them – so few differences that few doctors know these subtle differences, and usually choose a familiar one in each category. To have seven drugs in one category to choose from makes no sense at all; it drives costs up, and increases problems of stocking so many items. While the formulary is dynamic and changes must be kept under review, and ongoing changes (both additions and deletions) made, the principle of reducing these many “ME TOO” drugs is extremely sound and the Formulary Committee and Ministry are to be commended.

    The second matter, of the “Dispensing Fee”, is also perfectly reasonable. Patients who can afford a private physician consultation should have no serious problem with a token dispensing fee! Those who really think they do, have the option of having their prescription filled at a polyclinic pharmacy. The time taken, in the light of current health challenges for many in need, is another consideration. One might take along a good book for any extra wait. This practice, as in the UK, was recommended when our Drug Service was inaugurated. It encourages appreciation of the true cost of drugs and discourages “doctor shopping”, duplication of prescription and wastage of costly “free drugs”; but the advice given to the BDS and Ministry of Health in 1980 was not followed. Instead, a drug levy, 1 per cent of income, I believe, was introduced for a few years. The vociferous objectors now appear to be unaware that Barbados has economic problems. Further unnecessary confusion also exists because of the varying scale of dispensing fee, according to the cost of the specific medication – as opposed to a set fee per item, which is sending mixed signals, and the facts should be more clearly stated.

    In the final analysis, we have been wasting a fortune in unnecessarily costly drugs in Barbados. The rationalising of our Formulary and drug supply practices along the lines of the World Health Organisation recommendations is both sound, sensible and necessary, if our predominantly “free health system and drug service” are to remain.

    Henry S. Fraser
    Emeritus Professor of Medicine and Clinical Pharmacology, UWI

    http://www.barbadosadvocate.com/newsitem.asp?more=letters&NewsID=18074

  2. Amused Avatar
    Amused

    @GP. Excellent advice. Thank you.

  3. Pooposition Is At Sea Avatar
    Pooposition Is At Sea

    It is also worthy to note that only last week that the Gov’t received a visit from sales and marketing persons from one of the big drug manufactures that previously had one of their products on the Formulary and they have pleaded to get it back on the Formulary because of the prestige and recognition of that particular brand of drug and they do not want it removed even though their alternate drug is being used with good results.

    The fact of the matter is that they are earger to have the drug reinstated and the have offered to reduce the price of their brand name drug by 40 % to make it an acceptable price so that it can be reinstated on the Formulary, now had this gov’t not taken this stance these same drug companies would have continued to make as much as they could our of our people and smile all the way to the bank.

    What will be of major interest now is will it be the case that the other drug providers follow in this first providers footsteps and offer the Ministry of Health a much more reasonable priced product that will be easier to swallow for both the Ministry of Health and the Ministry of Finance ???

    I think this has exposed what these drug manufactures have been doing to Barbados for years now, ripping us off and thanfully with the enlightened leadership of an excellent Minister of Health it has been exposed for what they were doing in that they were taking Barbadians for a ride with their pricing of their drugs to be provided to the Drug Formulary

  4. David Avatar
    David

    The matter of the role the pharma agents play to manipulate the market needs probing/dismantling.

  5. just only asking Avatar
    just only asking

    @P at Sea

    I knew all along that those drug comapanies were taking advantage of barbados and the Caribbean, just like what lime used to do for a ride. The Minister of Health must be commended for standing up for what he think is right. I like him, He has intestinal fortitude. Dont mind those who were waiting in vain, such as ENUFF, the SCout, ROSEART, ISLANDD GAL AND BADFF or whatever.

    Generic Drug must Pharmacobia standarde before being added to the forrmulary. If my memeory serves me correctly,,Professor Fraser used to sit on the Drug Formualary. The Barbados Drug Service has served as a model and a centre of excellence. I know that for a fact.

    Donville take an A. You and your staff in Health must be commened for doing something that was lond overdue. The next thing is to make the QEH patient focus and not doctors focuc. I with you.

  6. just only asking Avatar
    just only asking

    @David

    I with you. The doctors role too. AT THE town hall meeting, a lady got up and ask questions about doctors owning pharmcacies, there need to be a policy on that too.

  7. well well Avatar
    well well

    In light of doctors owning pharmacies, should doctors prescribe antibiotics for the common cold? Isn’t this a wastage resources?

    If one goes to a doctor with a cold one is given antibiotics as a “placebo” . Plenty of fluids and rest is needed, unless the infection becomes bacterial.

  8. smooth chocolate Avatar
    smooth chocolate

    In terms of those drug companies trying to have those expensive brand name drugs back on the Formulary – i hope they were turned down and the Drug Service stick to their decision.. the drug companies might promised 40% reduction but then in the middle of the the contract, somehow, for some reason, there is a price increase. this has been happening over the years and the Drug Service is left to deal with the increase cost of the drug. it seems that they quote cheaper price just to be awarded a contract but then months after the contract has been awarded, the cost of the drug goes up.(this is from the distributors end).

  9. Hants Avatar
    Hants

    Thanks Dr.GP. Good info as usual.

    Unless I go bankrupt or completely broke, I will continue buying Brand name.

    I agree the GOB must try to cut cost but they must have knowledgeable people buying the drugs

  10. Hants Avatar
    Hants

    Well well wrote “If one goes to a doctor with a cold one is given antibiotics as a “placebo” . Plenty of fluids and rest is needed, unless the infection becomes bacterial.”

    Think about the crap you wrote.

  11. weary baje Avatar
    weary baje

    How come there is no Research & Development industry here for bio-med engineering?
    Why is it that we must always be looking to the outside to provide us with what we need?
    Are we only taught pride and no industry? Where is the industry?
    For a country that boast so highly of its education and yet at this time in age can’t inspire or raise up inventors or look at R & D as a solution to the many ills of this country is woeful .
    How come UWI turning out all types of medical students and no bio-med engineers?
    Shouldn’t the programs there be geared towards fulfilling the needs of this region?

  12. David Avatar
    David

    @Hants

    The key takeaway from GP’s submission is that not all generics are generics.

    You are correct when you opine that those people who procure drugs for the BDS must do it fully emboldened by what is happening in the market.

    The other point is that those who can afford brand name drugs, in the interest of the best health, should purchase from the private pharmacy.

    The government is in a bad place where entitlement has become embedded on our culture, the only issue here is that we need to protect the aged.

  13. David Avatar
    David

    Have scanned the news in the Nation newspaper today, please explain anyone how the PM slapped down Minister Inniss. Not grasping that connection at all.

  14. Enuff Avatar
    Enuff

    There is nothing wrong with reducing the number of drugs on the formulary in an effort to make the service more efficient but efficiency is NOT only measured by money saved. Additionally, the reduction does not necessarily mean less demand for drugs.
    The big savings are expected from the introduction of the dispensing tax, and I disagree with the Professor on this issue. For him to say that: “Patients who can afford a private physician consultation should have no serious problem with a token dispensing fee! ” is to trivialise legitimate reasons (primarily access, convenience and the opportunity to build a relationship with one’s doctor)
    why many bypass the polyclinic. Should only those attending polyclinics have access to the free publicly dispensed drugs too?. He also fails to acknowledge the additional costs households have had to face since 2008.

    @ Just Only Asking
    It is PM Stuart that said ‘I think not!’ and Minister Inniss that promised a review, both to the whole of Barbados not me.

    “The next thing is to make the QEH patient focus and not doctors focus”

    The Chairman tried that already and it flopped. The QEH must be CUSTOMER focused, which means both their internal and external customers. You really have a BA HONOURS and an MBA with distinction? OMFG

    @ David
    Part of being in a bad place with entitlements is of their own making.

  15. David Avatar
    David

    @Enuff

    The health ministry has always been problematic through the years.

    It seems under this administration it is no different.

  16. smooth chocolate Avatar
    smooth chocolate

    @weary baje | June 12, 2011 at 9:49 AM |
    How come there is no Research & Development industry here for bio-med engineering?
    Why is it that we must always be looking to the outside to provide us with what we need”

    ‘Carlisle laboratories in warrens, as far as i know does a fantastic job in barbados…i rarely hear anyone complain of the drugs they produce

  17. Sargeant Avatar
    Sargeant

    @Enuff

    He also fails to acknowledge the additional costs households have had to face since 2008

    **********

    Care to explain why you used 2008 as your benchmark?

  18. David Avatar
    David

    @Sargeant

    Isn’t that when the global economy went to hell in a handbasket?

  19. Enuff Avatar
    Enuff

    @ David
    We all, I hope, acknowledge that the management of the QEH has challenged government for years. This is why, especially with less money available, there is a need for comprehensive health care policies that are not framed in isolation, but within government’s overall social and economic development framework.

  20. weary baje Avatar
    weary baje

    As far as I am aware Carlisle Laboratories package and distribute, also manufacturers’ agent. They are not into research and development of drugs

  21. Sargeant Avatar
    Sargeant

    @David

    Nice of you to step in for “Enuff” but I think Dr. Fraser’s explanation was reasonable and made sense but I would have liked “Enuff” to elaborate on his timeline.

    It a Gov’t takes steps to alleviate a situation which would provide long term benefit to all should it postpone them under the rationale that households were faced with additional costs since 2008? According to Dr. Fraser the Gov’t of the day did not follow the proposed recommendation in 1980, 30 years later we are implementing the same proposals.

    In the 30 year interval how much money did the country have to pay? Some day we will eliminate the culture of “freeness’ that some feel entitled to, sadly that day is still far off

  22. David Avatar
    David

    @Sargeant

    Every decision we make now has to be driven by political considerations.

    Both parties know there is massive wastage in how healthcare is administered in Barbados but it is one of the biggest hot potato items along with education, so we just mosey along driven by the political considerations.

    At some point the crap will hit the fan. In fact we should be smelling something all like now.

  23. EyeSpy Avatar
    EyeSpy

    @ GP, kudos on the topic; quite interesting…
    I know someone who takes a brand name drug that costs $600US while the generic is $71US. When the pharmacist was asked about the huge disparity in cost, his response was “you get what you pay for; you’re getting the best.” The pharmacist went one step further to inform the person it would be more cost effective to join a mail order program and get a 3 month supply for the same price, instead of purchasing a one month supply.

    One of my relatives was taking a brand name drug for many years. When he refilled the prescription, he did not look to see if he received the correct drug. Whenever he took the drug his skin would itch and sting. This forced to check the label — it was a different name, so he thought he was given the wrong drug. When he contacted the pharmacist, he was told it was the same drug but under a new name. The pharmacist explained that insurance companies will not pay them (pharmacies) for dispersing brand name drugs if there is a generic brand available. The pharmacist suggested that he call his doctor and have his doctor write “No Substitute” on the prescription so that he can continue to get the brand name. He said that the pharmacist told him that it could be a change in an ingredient that caused the reaction.

    GP, if brand name and generic were as simple as you have explained, I don’t see why pharmacists can’t be more forthcoming in letting customers know there are getting the generic brand, if the prescription has been written for the brand name and that is the name the doctor may have said, or put the word “generic’ on the label — without the word, it looks as if there is something to hide.

  24. just only asking Avatar
    just only asking

    @Enuff

    is that all you have to say. You have lsot the argument long ago. So come againn. Further, professor fraser dont need any patrongae from you that is his filed of expertise, while yours is in ignorang.

    Yours faithully
    BA(HONS), MBA(DISTINCTION)

    Take Them as above.LOL

  25. just only asking Avatar
    just only asking

    For @enuff

    Icome again. “patronage” “field” “ignorance”

  26. just only asking Avatar
    just only asking

    @David

    The health ministry will always be problematic, there are too many vested interest, especailly in the hospital. When Jerome and the blp introduced the board it was to work wonders. What have we seen, an increased in staff and no operational efficency.

    The Consultants need to do work instead of working on their private patients. The managment information systems stink, that is what Enuff and his gang should be talking about, their board did not bring any change to the Hospital, except increased staff. equipment that was bought and could be found in corridors. under this Minister, the electrical upgrade has moved with speed. I hope that the new DM will introduce a culture of effiiciency in that institution.

    Staff now has a acnteen after so many years without one. What I want to see is reduced waiting time in the casualty, but the Minister has promised to place certain equipment in the poyclinics to take the load off the qeh.

    What i would like to see introduced is where persons are placed a in government or private homes, what property they have be sold to look after them, to stop family members who have abondoned them from benefitting. If that happens, you will hear people like ENUFF et al crying foul.

  27. Enuff Avatar
    Enuff

    @ Sargeant
    My reference date indicates the beginning of the current administration’s tenure and the global meltdown.

    “It a Gov’t takes steps to alleviate a situation which would provide long term benefit to all should it postpone them under the rationale that households were faced with additional costs since 2008?”

    Yes, because Barbados is more than an economy, it is a society!!

  28. Georgie Porgie Avatar
    Georgie Porgie

    1. @EyeSpy | June 12, 2011 at 6:19 PM |
    Thanks for your kind remarks .
    Re I know someone who takes a brand name drug that costs $600US while the generic is $71US. When the pharmacist was asked about the huge disparity in cost, his response was “you get what you pay for; you’re getting the best.”

    This is not necessarily true. TECHNICALLY BRAND NAME IS NOT NECESSARILY THE BEST, since all drugs have a brand name. What the pharmacist is trying to say that the original drug produced by its ‘discoverer’ might be better or ought to be better. But this depends on many factors.

    Note also that after the original manufacturer has losts its patent it might very well be selling a lot of its produce as “generic” via a subsidiary with a different brand name , or via repackagers who buy in bulk from the original manufacturer.

    Re One of my relatives was taking a brand name drug for many years. When he refilled the prescription, he did not look to see if he received the correct drug. Whenever he took the drug his skin would itch and sting. This forced to check the label — it was a different name, so he thought he was given the wrong drug. When he contacted the pharmacist, he was told it was the same drug but under a new name, ie it was a generic preparation made by an inferior manufacturer .

    RE He said that the pharmacist told him that it could be a change in an ingredient that caused the reaction. Note this would not be a change in THE INGREDIENT i.e the drug itself, but ingredients of an inferior nature that are used to stabilize the real ingredient. This is an important difference between “brands” of the same generic compound…..and brings us around to the concept of BIOAVAILABILITY. I WILL POST A NOTE ON THIS AFTERWARDS .

    Re The pharmacist explained that insurance companies will not pay them (pharmacies) for dispersing brand name drugs if there is a generic brand available. VERY TRUE THESE DAYS IN THE USA

    RE The pharmacist suggested that he call his doctor and have his doctor write “No Substitute” on the prescription so that he can continue to get the brand name. GOOD IDEA!

    RE GP, if brand name and generic were as simple as you have explained, I don’t see why pharmacists can’t be more forthcoming in letting customers know there are getting the generic brand, if the prescription has been written for the brand name and that is the name the doctor may have said, or put the word “generic’ on the label — without the word, it looks as if there is something to hide.
    I AGREE WITH YOU THAT MORE DUCATION HAS TO BE DONE BY BOTH DOCTORS AND PHARMACISTS ON THIS TOPIC

  29. Georgie Porgie Avatar
    Georgie Porgie

    EYESPY
    I will ask to David ask to upload a short snippet from one of my Pharm ppts on the subject of bioavailability, for sake of speed
    If you have any questions I would glad to try to answer them.

  30. David Avatar
    David

    Here is Doc GP’s presentation on the subject of BIOAVAILABILITY.

  31. EyeSpy Avatar
    EyeSpy

    @GP, thanks very much for taking time out of your schedule, which I believe is a busy one, to respond to my comments. Your responses are clear and concise. I shall review your presentation and other data you have provided.

    I confirmed with my doctor about the cost of an anti-rejection drug for kidney patients nearly $3,000.00US/a month. It’s beyond me why a drug at such an extremely high cost would be listed on any insurance formulary. [I guess drugs at such a high cost would require pre-authorization.]

    With the explanations you’ve given, I must add that all these revelations about prescribed drugs make me think more (LOL) about pharmaceuticals, pharmacists and even doctors in terms of writing prescriptions. IMO, it’s robbery without violence.

  32. Georgie Porgie Avatar
    Georgie Porgie

    LOL EYE SPY!
    TRUST ME MANY PHARMACISTS AND DOCTORS DONT THINK OF THE COSTS!
    MANY DOCTORS DONT KNOW THE COSTS OF THE DRUGS THEY PRESCRIBE

    YOU MADE A POINT FOR BETTER EDUCATION ON THESE ISSUES EARLIER WITH WHICH I CONCUR

    THE PHARMACEUTICAL COMPANIES AND PERHAPS LOWER THEIR PROFIT MARGIN? I DONT KNOW?

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