Conference moira::parenting

   Actually, I believe you are right... there was a topic somewhere that
   talked about it, but I don't know where...
   
   Anyway, the only piece of advise I can offer is this:  Communicate!
   
   Really... talk with the doctor when you get a prescription - find out
   what it is, how it acts, what its supposed to look like, what its
   supposed to taste/smell like, what the dosage should be, etc.  Then
   double check when you pick it up - if there's a question, ask.  If you
   don't get a satisfactory answer,  have the druggist call the doctor's
   office to confirm the prescription and clear up the questions.
   
   I don't always have time when I'm paying for the prescription to ask
   and check and open it up to smell it, but I've called the pharmacy
   back many times with questions on new prescriptions.
   
   I realize that checkup time at the doctor's office is often short and
   overbooked, but if you have the time, you can probably browse the
   doctor's own PDR right there before you leave the office.  At least
   you know they have a copy in case you can't find one elsewhere.
   
   I believe there's no way go guarantee that we will always get the
   right stuff - these folks are only human too.  I believe that being
   informed and asking questions is the only way to watch out for stuff
   like this.
   
   imo,
   
   - Tom

    
    I believe it might be note 767.  What a sad situation.

    Have your doctor always write "dispense as written" on the
    prescription.  A pharmacist is not allowed to substitute a generic
    in this case.  My pre-natal vitamins were prescribed that way.
    I believe the insurance company will pay for such a prescription 
    even if a cheaper generic is available
    
    Also, as a note, the label on the prescription will have D.A.W.
    (dispense as written) printed on it.  
     
    Terry

<    Have your doctor always write "dispense as written" on the
<    prescription.  

In Massachusetts, the law is that the pharmacist *has* to substitute a generic
unless the doctor specifies not to, and doctors usually *don't* specify 
otherwise.  All the more reason to discuss this with your doctor every
time you get a prescription, if you are concerned about this.

    Carol

    
    this law seems kind of silly "has" to substitute opposed to "can"
    substitute.  If all are prescriptions are generic - why are
    prescription drugs so expensive ? are we still charged the
    same $$ as the name brands?
    
    I thought only the dr could change a prescription - therfore, if you
    were given a prescription and went to have it filled and asked for the
    generic equivalent - you couldn't get the generic unless you/the pharm
    got "permission".
    

In Colorado, I would have had to request a generic.  In Massachusetts, I get
the generic whether I want it or not (unless the doctor specifically tells them
otherwise).  I really had to fight the first time I discovered that, and they
had to phone the doctor to get the doctor to tell them not to substitute a
generic. 

Amazing, isn't it?

      Carol

    My guess is that the insurance industry lobbied and got the law passed.
    This way they get the cheapest prescriptions, every time.
    
    I don't mind the generics, and I usually request them when I can.  But
    I'd prefer to be in control of this.  For example, some generic
    drugs for kids taste a little different.  If my child won't take it
    because the medicine isn't masked, then what have we accomplished?
    
    judy

I also think it is for the consumer.  Anyone who has to pay a fixed % (as
opposed to a fixed $3. or $5) of the price or the full price is better off
with the generic unless there is some real issue with it. 

This way, the law always says they get the least expensive.  If they have a
problem with the generic they can take it up with the doctor. 

I always buy the generic over the counter stuff, so I would want to always get
the generic prescription unless there was some specific issue (like when taste
is critical as previous noter stated). 

I think the law in Massachusetts was enacted as "consumer protection."
Insurance companies could have set their own policy, just as they do
for "reasonable and customary."

I had an interesting experience along these lines.  I had just had surgery
so I wanted to fill the painkiller prescription that the doctor had written.
The first pharmacy was out of the generic so they couldn't fill it.  Likewise
the second.  My wife had to shlep all over the place to fill it.  I'd have
been willing to pay the difference, but the law "protected" me from this.

    Not sure if they "have to" or not in NH, but I do know that the
    pharmacist CAN change the prescription somewhat.  Many times it's been
    written as liquid, and I've asked for pill-form instead (or vice
    versa), and had no problem.  Or it's been written as 1tsp of 125mg
    medicine, and I've had it filled as 1/2tsp of 250mg medicine instead,
    again w/out a problem (cuts down on the volume, makes it easier for the
    baby to take).  Maybe my pharmacy isn't supposed to do this, but they
    certainly do, without the bat of an eyelash.  And that's been w/
    several different pharmacists.  Of course I'm in there every other
    week, so maybe that has something to do with it (3 kids ya know...).
    
    "as is" seems to mean "as intended" in my experience

    Following up on thought that generics=non generics except for
    things like taste....
    
    I have heard that the reason for the 'difference' is that while the
    'active' ingrediant may be the same chemistry-wise, that the buffering
    solution or pill base is sometimes (generally) different. I assume this
    is why generics sometimes look and taste different. I believe I
    heard/read this in a discussion on allergies (i.e. sometimes folks can
    be allergic to the active ingrediant and sometimes it's the
    buffering/delivery base the active ingrediant is contained in; For the
    latter, some folks MUST use a particular brand?) Anyone out there have
    access to this kind of information?
    
    

    That's true OTC, anyway.  I like to use Sudafed when I have a cold;
    once I tried the CVS brand of pseudoephedrine.  Active ingredient
    (pseudoephedrine) is the same, but the "filler" was different (I
    compared the two boxes) and I experienced a very annoying "speed"
    effect for the duration of that pill.  [Nothing against mind-altering,
    I just don't want to be surprised by it :-) ]
    
    Leslie

    The MAJOR difference between generics and brand name drugs is the
    absorption rate ... sometimes this is related to the non-active
    ingredients ... sometimes to the formulation of the actual chemical
    drug.
    
    Pseudoephedrine is a perfect example ...  One of the side effects of
    Sudafed (and other decongestants) is to raise blood pressure.  If the
    absorption rate is too quick, you bp will go up very quickly, giving
    you the "buzz" Leslie experineced in .-1 ...  The way around this
    problem is to either go with the brand name, or to divide the dose
    and take it more often ... so for pseudoephedrine, instead of 1 tablet
    every 4 hours, try 1/2 tablet every 2.  It eliminates the rush.
    
    I take a medication for restless legs syndrome that I take 1 tablet
    every evening when it troubles me ... a whole tablet works fine,
    probably for about 6-8 hours.   1/2 tablet may or may not work, and
    higher doses don't help ... if 1 doesn't work, I have to live with my
    legs for the night.
    
    Now, a pharmacy substituted a generic last year ... much cheaper ...
    and it works ... sort of ...
    
    	the incidence of the drug not working is MUCH higher, especially
    	for whole tablet doses.
    
    	1/2 tablets work far more consistently, but not as effectively
    	as a half or whole brand name
    
    	higher doses of generic work no better than the smaller doses.
    
    This implies a) different absorption rate (slower - which is unusual -
    generics normally seem to absorb faster) and b) inconsistent amount
    of active medication per tablet or inconsistent absorption rate
    per tablet.
    
    The other big difference, of course, is the price ... Generic producers
    did not have the development costs (nor do they have the advertising
    costs either!) so the development cost has to be paid for solely by
    the brand-name manufacturer.  As a result of generics, and the
    insistence of dispensing generics, brandnames are kept almost
    artificially high priced ... this isn't a normal supply and demand
    market, because the playing field is not level.
    
    To some extent, I understand why the brandname producers are keeping
    their prices high, and sympathize, but if they lowered their prices
    sufficiently so as not to be pushed aside by gov't or insurance co's
    then there would not be quite such a disparity.  Generic producers
    could also focus on producing higher quality replacements.
    
    Stuart

    
    
    Each brand name drug has millions of dollars of investment 
    put into it for research (that sometimes means going to the
    rain forests looking for native medicines), prototyping, 
    clinical trials, FDA approvals, etc.  The brand names 
    manufacturers have to recuperate their cost. They are the 
    pharmaceutical pioneers. Without them, we won't have new drugs. 
    Generics manufacturers do not have the heavy overhead, they 
    just copy the brand names. 
    
    I have tried some generic OTC and most of the time, they don't
    work as well as expected.
    
    
    
    Eva