Generic Drugs – good choice, or bad?
I was interested to read this article from the New York Times this morning about the way that generic medication is seen in the US. In the UK it has long been the case that doctors must prescribe generic meds unless specifically stated on the prescription. This has saved massive amounts of money which has been used elsewhere in the NHS. However in the UK, partly because of the NHS, we don’t have medication advertising in the same way. This tends to be restricted to over the counter preparations like remedies for colds, flu, headaches or digestion problems. With prescribed meds the pharmacy is obliged to fill the script with a generic copy.
What I found most interesting about this article was the research that had been done to find out why more people didn’t use generic meds when there was a choice. Evidently some states enforce a ruling much like the one in place with the NHS but where there is a choice sometimes that choice is dictated by something other than price. In rural Alabama where the population is predominately poor and African-American there is a resistance to generics partly based on the feeling that just because they are poor and African-American, why should they have a cheaper version? This is especially interesting because evidently it is the higher cost of the original meds that means that prescriptions are often not filled or renewed. In other more affluent groups the generic copy is seen as giving better value for money. As I understand it, paying for medications in the US is dependent on the Medical Insurance that you have as to how much you pay. So why is the cheaper option not thought of first?
For those with breast cancer this is also a problem. In the UK, or certainly in England, you don’t have to pay for any prescriptions if you are having cancer treatment. Yet a study in Scotland http://www.nhs.uk/news/2013/09September/Pages/Stopping-tamoxifen-ups-breast-cancer-risk.aspx traced the refilling of prescriptions for those on Tamoxifen after their Early Stage dx, and those who didn’t continue to take the meds had a worse outlook than those who did. True, this may have more to do with side effects, but it can show the danger of not finishing a prescribed course of medication. Even then, are side effects like hot flushes really comparable to progressing to Metastatic Breast Cancer and death? Are patients made fully aware of the reasons for the need to continue to take Tamoxifen, or is it smoothed over as being, you’re cured but we want you to take this just in case … as though it was an optional extra.