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What’s in a Name? Brand vs. Generic Medications

May 02
20:56 2019

By: Dr. Abigail Joseph

“What’s in a name? That which we call a rose, by any other name would smell as sweet.” In the play “Romeo and Juliet,” Juliet implied that Romeo, even if he were called by another name, would still be her true love. William Shakespeare’s statement implied that names themselves do not hold worth or meaning but rather that it distinguishes one thing from another.

Have you ever had an affiliation to a specific brand name drug and when forced to make a switch due to lack of availability, find that the medication does not work the same? Is there some truth to this or is it a matter of our minds? Sometimes doctors would write a particular medication by its brand name rather than the generic name, and this is because they probably have in mind a particular brand they would like you to buy. However, you may have experienced going to the pharmacy and the pharmacist would explain to you that they don’t have that particular “brand” but then proceed to show you one that is “just as good” or explain that they have the “generic” to it, meaning not the brand but one of similar composition.

Many times as patients when we go to the pharmacy and see different medications with the same name, we look at the price and try to distinguish which is the better drug. In all honesty, sometimes we shop for medication the way we shop for groceries – look at the cheaper stuff as if something is wrong. There are many reasons why a particular drug is cheaper and by no means does it imply that it is of an inferior quality. Medications that are imported into Belize are vetted and there are rules and requirements that need to be met before a particular drug can be approved. According to protocol, before orders of medications can be imported into the country they need to be approved by the Chief Pharmacist who acts on the behalf of the competent authority, the Director of Health Services. I say this for you to understand that drugs that make it into the country on a large scale are vetted and are considered efficient and safe by our Ministry of Health. But why is it that sometimes when we make switches it feels different? Perhaps the metformin isn’t controlling your blood glucose as efficiently as the other brand. Why is your blood pressure still elevated?

Brand name medications are drugs that are owned by specific pharmaceutical companies who spend a lot of time in marketing, but also on research to ensure the efficiency, safety and that all the requirements and standards are met. In like manner generic drugs are required to meet particular standards as well and are measured by their brand named equivalent. For example, there are several forms of Acetaminophen but only one TYLENOL. Brand names spend a lot of time and money getting tested and approved before they arrive on shelves. Sometimes it takes years. Brand name drugs have patents that allow the pharmaceutical company that paid for the study, research and the marketing expenses of the drug to be the sole company that produces that drug; however, when a patent expires, a company can create a generic version of the brand name and once approved by the FDA they can go on the market. Generic medication only exist after the patent has expired, and this is one of the reasons why generic drugs are cheaper than their brand name counterparts. Generic drugs are approved when they are found to be pharmaceutically equivalent – the effect, safety, and efficiency are expected to be the same. A generic drug is considered bioequivalent if the manufacturer can prove that the active pharmaceutical ingredient (API) has the same rate and extent of absorption to that of the brand name drug when administered with the same dosage and under the same experimental conditions.

Although generic medications are required to have the same API as the original drug, they may have a difference in inactive ingredients, preservatives and fillers. Manufacturers of the generic formula are allowed to have up to 20% variation in API composition from the original formula. Studies have shown that most companies only use a 4% variation, which is a very insignificant number and as such the medication is still considered bioequivalent. It is also important to know that when a patent expires, sometimes the same company that created the original drug are also the makers of the generic. They would then sell them to other companies who then label and place them on the market. This is a true equivalent as it is the identical formula of the original brand name. In these cases patients unknowingly would refer that a particular generic brand is “better.” It can also be observed that it is possible for patients to have allergic reactions to a particular generic brand. This is not due to the API itself but often times due to particular inactive ingredients. Apart from the above mentioned, the only other difference that is significant between brand name drugs and generic medications would be the cost. Generic manufacturers do not have the expense of research and developing the formula, therefore their only competition is with other generic companies.

Here in Belize we have a wide collection of licensed pharmacies throughout the country that stock a collection of both brand name drugs and generic medications. Pharmacies are visited regularly to make sure that the drugs provided are approved for patient consumption. Having generic medication is not a bad thing. It provides variety as well as increases competition in prices. Studies show that when the medication prescribed by your doctor is affordable, a patient is more likely to complete therapy; whereas in cases of an expensive brand, studies reveal that at times patients modify how they take the drug if they are unable to buy the total treatment or skip it all together. Our government hospitals use a lot of generic medications and it has been very cost effective. Many countries are choosing generic medications and placing them as part of their national formulary because it results in considerable savings to the healthcare budget. From time to time you may notice that maybe the name of your generic medication changes and it’s probably because the medication came from somewhere else, but rest assured that many protocols are in place to ensure efficacy, safety and quality.

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