Are people on financial assistance really able to request costly brand name drugs over generics?

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How can we afford to be offering people on financial assistance the ability to choose a brand name drug over a generic if not specifically prescribed by a doctor?  Apparently this is happening.  People on financial assistance are able to choose brand name drugs to fill their prescriptions rather than generics and don’t have to pay a co-pay.  What’s the problem?  Brand name drugs tend to cost substantially more than the generic equivalents and in most cases have the same effect.  People who have their prescriptions covered via financial assistance should be required to use generics unless a brand name is specified by a doctor.  We simply can’t afford it otherwise.

In 2015/2016 we spent $55 million on financial assistance, that’s nearly $900 for every single Bermuda resident.  That’s no small amount of money.  While it is necessary that we give a helping hand to those at the bottom of society, we need to eliminate extravagant waste. Cutting down on waste and abuse in the form of generics vs. brand name prescriptions is one such area.   People on financial assistance are eligible to have their prescriptions covered 100%, generic or brand name without a co-pay.  A co-pay discourages people from unnecessarily choosing a brand name but when a co-pay doesn’t exist there’s no incentive to choose the cheaper option.

So brand name or generic medication, whats the difference?  If you had a headache and you were offered the choice of Tylenol or Acetaminophen which would you prefer? It shouldn’t matter.  Tylenol is simply the brand name used to market the common medication acetaminophen.  When a drug is originally produced it is subject to a patent and marketed under a brand.  Later after the patent expires, other companies are eligible to manufacture and sell it under other brand names which are commonly referred to as generics.

Let’s use another common example.  You’ve likely heard of Viagra but probably never heard of Sildenafil. They’re effectively the same.  It is commonly known as a treatment for erectile dysfunction but was originally created to treat pulmonary hypertension, but it’s a well known example so we’ll stick with it for this case. Viagra costs about 50 times more than Sildenafil and yet they’re effectively the same drug.  In the US, generics are not available yet.  However since we can import from the EU, we are able to acquire generic versions vs. the brand name.  Should we be requiring people on financial assistance to use the generic rather than the more expensive brand name?  

(No idea if people on financial assistance are getting viagra, it is just a laymans example)

Wait, is there a time when generics don’t work?  Yes, generics are not always an exact copy of the original drug and can have slightly different interactions with other drugs or symptoms in people.  Thus there are occasions when a doctor or pharmacist will specifically advise the use of a brand name drug due to known side effects or conflicts of a generic with other medications.  Thus there are occasions when a brand name is specifically prescribed by a medical professional vs. a generic.  So, if a brand name is specifically prescribed, it does make sense to dispense it and is justifiable for people on financial assistance.

Should people on financial assistance be able to be dispensed brand name drugs if a generic exists and they weren’t specifically prescribed the brand name?  It certainly would mean a considerable cost difference.  The tax payer is ultimately the one footing the bill and we can’t afford to be wasteful.  People on financial assistance should be required to take generic versions of medications if available unless a brand name is specified by a medical professional.

Disclaimer: I’m not a medical professional and had a chat with a pharmacist regarding details on this piece.  None of this constitutes medical advice and you should consult a doctor or pharmacist for any medical needs or concerns.

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