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Generic drugs just as effective, but cost less

By DAVID LIPSCHITZ
Published August 29, 2006

When two major drug patents expire this year, there will be dramatic price decreases as generic brands of these medications are developed.

The first drug to lose its patent is Zocor, a powerful medication to lower cholesterol. Produced initially by Merck, Zocor will be available in a generic form. To keep Zocor competitive with those versions, Merck has slashed the cost of the drug.

Generic Zocor also is likely to be prescribed over the more expensive Lipitor and Crestor, which would lead to billions of dollars in lost revenue for their manufacturers, Pfizer and AstraZeneca.

Within the next few months, Zoloft, an antidepressant, also will come off patent, resulting in a twofold or threefold reduction in cost.

Despite such drops in cost, many patients will still be reluctant to switch to generic medications. However, there generally is no evidence that a generic form of a medication is less effective, less well produced or has more side effects than the brand-name form. Unfortunately, the psychological perception that "expensive" means better applies to the medical arena as well as many others.

Among the other reasons generics are not used more widely:

* First is patient preference. Many people state, usually without good reason, that they are unable to tolerate the generic form, that they are allergic to contaminants in the generic pill or that they believe the generics are poorly made and contain inaccurate doses.

These days, companies that produce generics are multibillion-dollar businesses, have excellent quality control, and, more important, are regulated by the Food and Drug Administration.

* Patients sometimes cite their excellent insurance coverage as a reason not to use generics. Brand name drugs and generics have the same co-payment, so "why not get the best?" Insurance companies have grown more savvy, however, and are either insisting on or providing incentives for the use of cheaper generics.

* Physician prescribing habits. We tend to prescribe the newest medication. For example, Lipitor and Crestor, two newer statins, are much more powerful than Zocor. Dose for dose, they lower the bad or LDL cholesterol more than Zocor. The probable reduction in LDL by 10 mg of Crestor requires 40 mg of Zocor, so why not use the more powerful medication?

This prescription should be written only if a maximum dose of Zocor fails to lower the cholesterol level sufficiently. If it doesn't, a more powerful medication is warranted.

* Physicians also are affected by pharmaceutical companies' marketing that is directed at them and their patients. Almost daily, patients ask me about specific treatments that they have either seen on TV or read about in advertisements.

Direct marketing to physicians creates so many ethical dilemmas that the American Medical Association has issued stringent new guidelines for the way in which physicians and pharmaceutical representatives should interact.

Free lunches for workers in medical clinics are an almost daily event. And then there is the closet full of samples. When starting a treatment, doctors often start with a sample, to ensure the medication will be effective. Once the patient starts taking the drug, change to a generic is infrequent. The samples closet usually does not contain generic versions.

Readers can send e-mail to Dr. David Lipschitz at askdrdavid@msn.com More information is available at www.drdavidhealth.com.

Creators Syndicate

[Last modified August 28, 2006, 19:11:38]