Take the Generic Drug, Patients Are Told Unless Insurers Say No

[babylonsister]

Take the Generic Drug, Patients Are Told — Unless Insurers Say No
Posted on Aug 7, 2017
By Charles Ornstein / ProPublica, and Katie Thomas / The New York Times


It’s standard advice for consumers: If you are prescribed a medicine, always ask if there is a cheaper generic.

Nathan Taylor, a 3-D animator who lives outside Houston, has tried to do that with all his medications. But when he fills his monthly prescription for Adderall XR to treat his attention-deficit disorder, his insurance company refuses to cover the generic. Instead, he must make a co-payment of $90 a month for the brand-name version. By comparison, he pays $10 or less each month for the five generic medications he also takes.

“It just befuddles me that they would do that,” said Taylor, 41.

A spokesman for his insurer, Humana, did not respond to multiple emails and phone calls requesting comment.

With each visit to the pharmacy, Taylor enters the upside-down world of prescription drugs, where conventional wisdom about how to lower drug costs is often wrong.

Consumers have grown accustomed to being told by insurers — and middlemen known as pharmacy benefit managers — that they must give up their brand-name drugs in favor of cheaper generics. But some are finding the opposite is true, as pharmaceutical companies squeeze the last profits from products that are facing cheaper generic competition.

Out of public view, corporations are cutting deals that give consumers little choice but to buy brand-name drugs — and sometimes pay more at the pharmacy counter than they would for generics.

more...

http://www.truthdig.com/report/item/take_the_generic_drug_patients_are_told_unless_insurers_say_no_20170807

[Vinca]

1. Sometimes it seems like you really get blindsided, too.

You'll fill prescriptions and pay little for generic drugs and then - suddenly - something pops up that is ridiculously expensive and not sufficiently covered. I've seen people walk away from the pharmacy counter without their prescriptions more than once. We need price controls in this country on everything from aspirins to brain surgery.

[Hieronymus]

2. Humana's getting a kickback from the drug manufacturer.

[elehhhhna]

8. No they're paying a much lower rate than the $90 co-pay

No they're paying a much lower rate than the $90 co-pay and the difference between what the patient pays and what the insurance pays is reimbursed to the insurer by the pharmacy. So yeah it's kind of a kickback

[COLGATE4]

3. It may be the Insurance but often this

results from the Doctor having designated the prescription as "DAW", i.e. dispense as written. If that's the case the pharmacy's hands are tied - they have to fill the prescription exactly as the physician has written it. If is says 'x dose of "Brand name" once a day" they have to fill it with "Brand name".

[Demit]

5. This article is not about that.

It's about drug companies cutting deals w/insurers and pharmacies to strong-arm patients into buying their drugs. Doctors are even being told they MUST prescribe proprietary drugs and not the generic forms:

"Dr. Lawrence Diller, a behavioral pediatrician in Walnut Creek, California, said he began noticing “very odd things” going on with Adderall XR and other attention-deficit drugs about two years ago. He began receiving faxes from pharmacies telling him that he had to specify that patients required brand-name versions of the drugs.

He had been practicing for 40 years, but until then had never had a pharmacy tell him he had to prescribe a brand-name drug instead of a generic. ..."

[HAB911]

4. Someone has to pay for all these TV commercials

Like the judge told me during my divorce, "Boy, somebody has to pay and you make all the money"

Follow the money

[TexasProgresive]

6. I wonder if Mr. Taylor got his doctor to write the script for the generic by name

if that would work. There were alternatives to the EpiPen but the prescription had to be for the alternative by name. I realize this is a device. I take Metformin which is the generic of Glucophage. My script is for Metformin not Glucophage.

Edit: I guess not after reading the article:

The continued success of the brand-name drug Adderall XR, long after generic competitors arrived on the market, is a case in point.

Dr. Lawrence Diller, a behavioral pediatrician in Walnut Creek, California, said he began noticing “very odd things” going on with Adderall XR and other attention-deficit drugs about two years ago. He began receiving faxes from pharmacies telling him that he had to specify that patients required brand-name versions of the drugs.

He had been practicing for 40 years, but until then had never had a pharmacy tell him he had to prescribe a brand-name drug instead of a generic.

“It’s Alice-in-Wonderland time in the drug world,” he said.

[Igel]

10. That was the pharmacy.

And this happened to me once.

I went with the (written) prescription and was caught in a bind: The pharmacy did not stock the generic, the insurance company would only pay for the brand-name if explicitly prescribed. They contacted the doctor who said "yes, brand-name".

Another time I was told to go a few miles to a different "branch" of the pharmacy. They didn't have it where I went, they did a few miles away.

This makes sense. The pharmacy building may be 15 years old. Since then there may be 100 new drugs and 100 drugs that split into brand-name and generic versions. They each take up space. They take up money sitting in inventory. Not every pharmacy will carry everything, esp. when each drug has a shelf-life. Adderall's fairly common, though.



When I was facing levothyroxine for life I was also told I had a few options. Now. l-thyroxine has a million generic versions, it's a hormone and both cheap and easy to make. Except that different brands of generics, even at the same strength, had different levels of effectiveness. The options I was given were two: (1) Go with the established brand name because that was the basis on which prescriptions were written; (2) Go with a generic, but make damned sure that it was the same manufacturer year after year because over the course of the first year or so the doctor would have to play with the prescription to get the right effect. That usually meant going to the same pharmacy and not transferring the prescription. (Years later the FDA changed the requirements for this particular drug from "same strength dosage" to "same level of efficiency" because it was such a problem and the drug's so commonly prescribed, so while I'm prescribed 125 micrograms/day all I know for sure is that each generic pill is effective as the brand-name variety's dose of 125 micrograms--it might have 120 or 130 micrograms of the active chemical.)


Online a lot of people complain about (some) generic Adderall not being as effective as the brand-name.

[David__77]

7. If the generic retail cost is low, get it anyway.

Perhaps the full cost of the generic is less than the brand name copayment. Shopping for the right pharmacy may help too.

[Wounded Bear]

9. At the VA, I get generics all the time...

at least they haven't infiltrated that market.

[countryjake]

11. K&R!