Buying into generic drugs

It is amazing how something so small can cost so much. Whether it is a short-term treatment, or multiple drugs you take indefinitely, prescription drugs have the potential to drain your savings.

However, there are many cheaper generic versions of more expensive brand-name drugs. In fact, almost 80% of prescriptions are for generic drugs, according to the Food and Drug Administration (FDA), and on average they cost about 80% to 85% less than brand names. Odds are there is generic version to treat your condition, too, whether it is chronic pain, high cholesterol, high blood pressure, diabetes, asthma, or depression.

But is there a difference between generic and name brand other than price? To better understand this, you have look at how drugs are made, manufactured, and prescribed.

Types of generic drugs

There are two ways generic drugs are used: generic substitution and therapeutic interchange.

Generic substitution means the drug is the equivalent to a brand name on a molecular level. "In terms of effectiveness and quality they are the same, and the FDA has certified both are equal," says Dr. Niteesh K. Choudhry, assistant professor of medicine at Harvard Medical School. Dr. Choudhry's research focuses on strategies to improve health care quality and reduce spending. An example is the cholesterol drug Lipitor and the generic version atorvastatin.

Therapeutic interchange is slightly different. The generic is a medical substitute that is molecular related, but not exactly the same. "It is like the difference between a Coke and a store brand cola," says Dr. Choudhry. Therapeutic interchange is often used for name brands that do not yet have a generic substitution because the brand name patent still exists.

Are therapeutic interchange drugs just as effective as brand names? For the most part, yes, says Dr. Choudhry. "It depends on the drug, what it is designed to treat, and the person, but it often is equally effective. Of course, the downside is they are not 100% guaranteed to work."

However, most research tends to support the effectiveness of both types of generic drugs. A 2015 report published in the Jan. 5, 2016 issue of the Annals of Internal Medicine advocated the greater use of generic drugs, citing research that supports its overall equality with brand-name counterparts as well as its valuable cost-savings.

Consult with your doctor

Do not assume your doctor will always offer you the choice of a generic drug. A 2016 ProPublica analysis found that doctors who receive payments from the medical industry tend to prescribe more brand-name drugs, on average, than those who do not. The report does not prove that industry payments sway doctors to prescribe specific drugs, or even a particular company's drugs, but it does show payments are associated with that trend.

Even if doctors are not part of this arrangement, they may prescribe brand names based on their medical preference and past success with patients, says Dr. Choudhry. "Also, doctors may not know a generic version of a therapeutic interchange has become available since it is unusual for generics to be officially announced," he says.

Dr. Choudhry suggests that people be proactive when prescribed any medication and always inquire if there are generic versions available. Another option: in many states pharmacies can switch to a generic substitution — but not a therapeutic interchange — as long as there is no "dispense as written" requirement from your doctor.

Remember that most drugs, whether brand name or generic, do not work the same for everyone. Yet, if a generic drug is not successful, you are not forced to switch to the brand name. "Some drugs have multiple generic versions," says Dr. Choudhry. "So often you have more options from which to choose."