Why I Hate Generics

I was a pharmaceutical rep for seven years. My closest friend is still a pharmaceutical rep, and we talked today about her struggles selling a branded drug against the onslaught of generics. As a salesperson, I fought the good fight against generics every day. As a disclaimer to everything I am about to say, I am still pro-pharmaceutical industry. But now that I take a daily chronic medication, I feel the need to advocate from the patient perspective.

There are several reasons I refuse generic medication, but here are the most important reasons:

1. Generic drugs are only required to have between 75% and 125% bioavailability (active drug in the bloodstream). Branded medications are required to have 100% bioavailability at all times. I currently take 125 mcg of Synthroid. That’s less than 1 mg. A variability of 25% either way could absolutely affect my daily life. Read more here.
2. Generic drugs must have the same ACTIVE drug as the branded medication, but God only knows what they use for inactive ingredients. My guess is that they use whatever is the absolute cheapest. Inactive ingredients affect absorption, and also contribute a great deal to the side effect profile of a medication. Patients also often have allergies to these additives. Read more here.
3. A large portion of generic medications are manufactured in India and China, where quality control standards are far below that of the U.S. Read more here.
4. Generic levothyroxine has been PROVEN to be inferior to branded Synthroid in multiple clinical studies. Ironically, I used Synthroid as an example for why doctors shouldn’t switch their Actonel patients to generic Fosamax. Little did I know I would live and breathe that study just four years later. Read more here. 

So you might think this doesn’t matter, because your doctor doesn’t prescribe generic drugs. But guess what? Unless the doctor specifically writes D.A.W. -DISPENSE AS WRITTEN on your prescription, a pharmacist can switch it out with a generic. And you might get a different generic manufacturer every single time you refill…different bioavailability, different inactive ingredients and different quality on a month-to-month basis.

I went into this experience as a very educated patient. I specifically asked for a D.A.W. prescription from the moment I woke up from surgery. Yet on FIVE different occasions over the past six months, I have been harassed at the pharmacy to switch to a generic.

“Sarah – we didn’t fill your prescription because your co-pay is $30. Are you okay with that?”

“We don’t have any Synthroid, but we have levothyroxine, which is the same thing.”

I just want to scream every time. It is NOT the same thing! Pharmacists do this to patients because the profit margin on generic drugs is HUGE compared to their branded counterparts, and inventory costs are much lower. Therefore retail stores incentivize pharmacists to convert to generic drugs. I am all about Capitalism…I really, really am…but at least give me the opportunity to get what I pay for. At least be truthful and say there is a cheaper option, but it might be less effective.

So, fellow thyroid warriors, be educated. Ask questions. And be prepared for one more battle in the war for optimal treatment.

Tags: generic synthroid